Healthcare Provider Details

I. General information

NPI: 1881194249
Provider Name (Legal Business Name): BALANCE NC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 N SHARON AMITY RD
CHARLOTTE NC
28205-7921
US

IV. Provider business mailing address

1927 N SHARON AMITY RD
CHARLOTTE NC
28205-7921
US

V. Phone/Fax

Practice location:
  • Phone: 704-200-9355
  • Fax:
Mailing address:
  • Phone: 704-200-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12854
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-24973
License Number State

VIII. Authorized Official

Name: MONICA M SERRANO
Title or Position: DIRECTOR
Credential: LPC, BCBA
Phone: 704-200-9355