Healthcare Provider Details

I. General information

NPI: 1366060170
Provider Name (Legal Business Name): STRIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 AYRSLEY TOWN BLVD STE 202
CHARLOTTE NC
28273-4068
US

IV. Provider business mailing address

2015 AYRSLEY TOWN BLVD STE 202
CHARLOTTE NC
28273-4068
US

V. Phone/Fax

Practice location:
  • Phone: 704-614-5834
  • Fax:
Mailing address:
  • Phone: 704-614-5834
  • 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 Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER Y HARRINGTON
Title or Position: FOUNDER
Credential: LCSW
Phone: 704-614-5834