Healthcare Provider Details

I. General information

NPI: 1205243268
Provider Name (Legal Business Name): RESOURCEFUL SOLUTIONS III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 RAMA ROAD B
CHARLOTTE NC
28215
US

IV. Provider business mailing address

2301 RAMA RD B
CHARLOTTE NC
28212-6237
US

V. Phone/Fax

Practice location:
  • Phone: 980-213-5501
  • Fax: 704-563-3356
Mailing address:
  • Phone: 980-213-5501
  • Fax: 704-563-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE TYSON
Title or Position: DIRECTOR
Credential:
Phone: 980-213-5501