Healthcare Provider Details

I. General information

NPI: 1740185719
Provider Name (Legal Business Name): GROWELL THERAPY COLLECTIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 S TRYON ST UNIT B3204
CHARLOTTE NC
28273-4300
US

IV. Provider business mailing address

8116 S TRYON ST UNIT B3204
CHARLOTTE NC
28273-4300
US

V. Phone/Fax

Practice location:
  • Phone: 704-954-8023
  • Fax:
Mailing address:
  • Phone: 704-954-8023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA MOUZON
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCMHC
Phone: 704-954-8023