Healthcare Provider Details

I. General information

NPI: 1871869834
Provider Name (Legal Business Name): N2 POTENTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 LENNOX SQUARE RD
CHARLOTTE NC
28210-9458
US

IV. Provider business mailing address

PO BOX 32846
CHARLOTTE NC
28232-2846
US

V. Phone/Fax

Practice location:
  • Phone: 704-605-4906
  • Fax: 704-552-0667
Mailing address:
  • Phone: 704-756-7339
  • Fax: 704-552-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NATASHA C FETTERSON
Title or Position: EXECUTIVE DIRECTOR/FOUNDER
Credential:
Phone: 704-605-4906