Healthcare Provider Details

I. General information

NPI: 1659862316
Provider Name (Legal Business Name): CREATE YOUR CALM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 SARDIS RD N STE 207
CHARLOTTE NC
28270
US

IV. Provider business mailing address

PO BOX 1091
MATTHEWS NC
28106-1091
US

V. Phone/Fax

Practice location:
  • Phone: 704-879-5483
  • Fax: 844-644-5238
Mailing address:
  • Phone: 704-879-5483
  • Fax: 844-644-5238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10252
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011732
License Number StateNC

VIII. Authorized Official

Name: AIMEE WHALEY
Title or Position: OWNER THERAPIST
Credential: MS, LPC
Phone: 704-879-5483