Healthcare Provider Details

I. General information

NPI: 1326437179
Provider Name (Legal Business Name): HEAVENLY HANDS FAMILY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 NATIONS FORD RD
CHARLOTTE NC
28217-8014
US

IV. Provider business mailing address

7950 NATIONS FORD RD
CHARLOTTE NC
28217-8014
US

V. Phone/Fax

Practice location:
  • Phone: 704-763-2318
  • Fax: 704-909-6946
Mailing address:
  • Phone: 704-763-2318
  • Fax: 704-909-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VINCENT MITCHELL
Title or Position: CEO
Credential:
Phone: 704-763-2318