Healthcare Provider Details

I. General information

NPI: 1649124371
Provider Name (Legal Business Name): VSPACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 BRAXFIELD DR
CHARLOTTE NC
28217-4016
US

IV. Provider business mailing address

710 BRAXFIELD DR
CHARLOTTE NC
28217-4016
US

V. Phone/Fax

Practice location:
  • Phone: 704-421-0903
  • Fax:
Mailing address:
  • Phone: 704-421-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: VICTOR VAZQUEZ
Title or Position: CEO
Credential:
Phone: 704-421-0903