Healthcare Provider Details

I. General information

NPI: 1841962602
Provider Name (Legal Business Name): THERAPY GROUP OF CHARLOTTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 REMOUNT RD STE C1
CHARLOTTE NC
28203-6459
US

IV. Provider business mailing address

125 REMOUNT RD STE C1
CHARLOTTE NC
28203-6459
US

V. Phone/Fax

Practice location:
  • Phone: 980-580-3532
  • Fax:
Mailing address:
  • Phone: 980-580-3532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY R BRENNER
Title or Position: PARTNER
Credential: PHD
Phone: 202-986-5941