Healthcare Provider Details

I. General information

NPI: 1881598654
Provider Name (Legal Business Name): NEXTGEN BEHAVIORAL WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13534 PLAZA ROAD EXT STE 5007
CHARLOTTE NC
28215-8921
US

IV. Provider business mailing address

13534 PLAZA ROAD EXT STE 5007
CHARLOTTE NC
28215-8921
US

V. Phone/Fax

Practice location:
  • Phone: 704-807-1588
  • Fax:
Mailing address:
  • Phone: 704-807-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN DAVIS
Title or Position: PARTNER
Credential:
Phone: 704-807-1588