Healthcare Provider Details

I. General information

NPI: 1114611696
Provider Name (Legal Business Name): COLIBRI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 MOCKINGBIRD LN # 420
CHARLOTTE NC
28209-3236
US

IV. Provider business mailing address

3439 VICTORIA BROOK LN
CHARLOTTE NC
28208-4257
US

V. Phone/Fax

Practice location:
  • Phone: 980-304-3203
  • Fax: 980-246-3971
Mailing address:
  • Phone: 980-333-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. INDIANA TORRES
Title or Position: OWNER
Credential: LCSW
Phone: 980-333-7422