Healthcare Provider Details

I. General information

NPI: 1073463584
Provider Name (Legal Business Name): A SPECIAL JOURNEY SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16207 LONG TALON WAY
CHARLOTTE NC
28278-8703
US

IV. Provider business mailing address

16207 LONG TALON WAY
CHARLOTTE NC
28278-8703
US

V. Phone/Fax

Practice location:
  • Phone: 704-648-8236
  • Fax:
Mailing address:
  • Phone: 704-648-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SOPHIA HATTEN
Title or Position: MANAGING MEMBER
Credential:
Phone: 704-648-8236