Healthcare Provider Details

I. General information

NPI: 1477982999
Provider Name (Legal Business Name): MISS HOLLY MICHA WELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 CENTURY OAKS LN
CHARLOTTE NC
28262-3156
US

IV. Provider business mailing address

2225 CENTURY OAKS LN
CHARLOTTE NC
28262-3156
US

V. Phone/Fax

Practice location:
  • Phone: 704-962-1019
  • Fax:
Mailing address:
  • Phone: 704-962-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14052610
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: