Healthcare Provider Details

I. General information

NPI: 1164359865
Provider Name (Legal Business Name): ERIK KIEFER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BAXTER ST STE 450
CHARLOTTE NC
28204-3026
US

IV. Provider business mailing address

2085 CUTTER POINT DR APT 205
CLOVER SC
29710-4630
US

V. Phone/Fax

Practice location:
  • Phone: 704-625-4841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: