Healthcare Provider Details

I. General information

NPI: 1639841893
Provider Name (Legal Business Name): VITAL CARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E 6TH ST STE 103
CHARLOTTE NC
28202-2918
US

IV. Provider business mailing address

13724 RIDING HILL AVE
CHARLOTTE NC
28213-4251
US

V. Phone/Fax

Practice location:
  • Phone: 704-430-1038
  • Fax:
Mailing address:
  • Phone: 704-430-1038
  • Fax:

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: MRS. CRYSTAL SIMMONS
Title or Position: OWNER
Credential:
Phone: 704-430-1038