Healthcare Provider Details

I. General information

NPI: 1356916357
Provider Name (Legal Business Name): CREATE THE PAUSE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 ACADEMY ST
CHARLOTTE NC
28205-1720
US

IV. Provider business mailing address

1923 ACADEMY ST
CHARLOTTE NC
28205-1720
US

V. Phone/Fax

Practice location:
  • Phone: 704-975-4893
  • Fax: 704-559-3772
Mailing address:
  • Phone: 704-975-4893
  • Fax: 704-559-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. COURTNEY DILIBERTO
Title or Position: OWNER, THERAPIST
Credential: LCSW
Phone: 828-394-9276