Healthcare Provider Details

I. General information

NPI: 1710761036
Provider Name (Legal Business Name): ROSALBA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BILLINGSLEY RD
CHARLOTTE NC
28211-1009
US

IV. Provider business mailing address

9616 E W T HARRIS BLVD
CHARLOTTE NC
28227-1287
US

V. Phone/Fax

Practice location:
  • Phone: 704-572-3884
  • Fax:
Mailing address:
  • Phone: 704-293-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: