Healthcare Provider Details

I. General information

NPI: 1962610121
Provider Name (Legal Business Name): SARAH MELISSA RIETH D.MIN.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 7TH ST
CHARLOTTE NC
28202-2127
US

IV. Provider business mailing address

115 W 7TH ST
CHARLOTTE NC
28202-2127
US

V. Phone/Fax

Practice location:
  • Phone: 704-749-6143
  • Fax:
Mailing address:
  • Phone: 704-749-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number58
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: