Healthcare Provider Details

I. General information

NPI: 1871851113
Provider Name (Legal Business Name): P&G CLINICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 ARROWRIDGE BLVD STE 150
CHARLOTTE NC
28273-5874
US

IV. Provider business mailing address

8201 ARROWRIDGE BLVD STE 150
CHARLOTTE NC
28273-5874
US

V. Phone/Fax

Practice location:
  • Phone: 704-408-8489
  • Fax: 855-532-2779
Mailing address:
  • Phone: 704-408-8489
  • Fax: 855-532-2779

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: LOREDANA PAMPINELLA
Title or Position: CEO/LPC
Credential: PHD(C), LPC, LCAS-A
Phone: 704-408-8489