Healthcare Provider Details

I. General information

NPI: 1700622164
Provider Name (Legal Business Name): VANNETTE JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8535 CLIFF CAMERON DRIVE SUITE 100
CHARLOTTE NC
28269-5909
US

IV. Provider business mailing address

1221 RESOURCE DR APT 112
CHARLOTTE NC
28262-4706
US

V. Phone/Fax

Practice location:
  • Phone: 704-717-7477
  • Fax: 704-717-7457
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: