Healthcare Provider Details

I. General information

NPI: 1407707649
Provider Name (Legal Business Name): PRECIOUS HEALTH AND WELLNESS SPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 DERITA AVE
CHARLOTTE NC
28269-3019
US

IV. Provider business mailing address

2945 DERITA AVE
CHARLOTTE NC
28269-3019
US

V. Phone/Fax

Practice location:
  • Phone: 404-542-0704
  • Fax:
Mailing address:
  • Phone: 404-542-0704
  • Fax:

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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: PRECIOUS STEPHENS KELLY
Title or Position: OWNER AND OPERATOR
Credential:
Phone: 404-542-0704