Healthcare Provider Details

I. General information

NPI: 1477870061
Provider Name (Legal Business Name): CONNECTIONS BWB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 UNIVERSITY EXEC PARK DR SUITE 655
CHARLOTTE NC
28262-1350
US

IV. Provider business mailing address

8430 UNIVERSITY EXEC PARK DR SUITE 655
CHARLOTTE NC
28262-1350
US

V. Phone/Fax

Practice location:
  • Phone: 704-596-5553
  • Fax: 704-596-1556
Mailing address:
  • Phone: 704-596-5553
  • Fax: 704-596-1556

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 Code253J00000X
TaxonomyFoster Care Agency
License Number150
License Number StateNC

VIII. Authorized Official

Name: MS. PHYLLIS HOWARD
Title or Position: SERVICES ANALYST
Credential:
Phone: 704-596-5553