Healthcare Provider Details

I. General information

NPI: 1881351005
Provider Name (Legal Business Name): YAMARA CHAMPION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 LATROBE DR STE 340
CHARLOTTE NC
28211-4823
US

IV. Provider business mailing address

2701 BOBWHITE CIR
WINGATE NC
28174-9657
US

V. Phone/Fax

Practice location:
  • Phone: 704-247-6658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: