Healthcare Provider Details

I. General information

NPI: 1720122757
Provider Name (Legal Business Name): AURORA FAMILY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 BRIGHTON PARK DR SUITE 400 PMB 264
CHARLOTTE NC
28227-7987
US

IV. Provider business mailing address

7110 BRIGHTON PARK DR SUITE 400 PMB 264
CHARLOTTE NC
28227-7987
US

V. Phone/Fax

Practice location:
  • Phone: 704-545-4935
  • Fax: 910-572-1768
Mailing address:
  • Phone: 704-545-4935
  • Fax: 910-572-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1655
License Number StateNC

VIII. Authorized Official

Name: MR. BRIAN JOSEPH BAUDUIN
Title or Position: CEO
Credential:
Phone: 704-545-4935