Healthcare Provider Details

I. General information

NPI: 1780343590
Provider Name (Legal Business Name): FAITH ALEXIS DIONA HAMPHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 MALLARD CREEK RD STE 509
CHARLOTTE NC
28262-9708
US

IV. Provider business mailing address

10150 MALLARD CREEK RD STE 509
CHARLOTTE NC
28262-9708
US

V. Phone/Fax

Practice location:
  • Phone: 980-308-4500
  • Fax:
Mailing address:
  • Phone: 980-308-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: