Healthcare Provider Details

I. General information

NPI: 1700631066
Provider Name (Legal Business Name): MENDING PEACES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2024
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9029 J M KEYNES DR UNIT 64
CHARLOTTE NC
28262-8408
US

IV. Provider business mailing address

9029 J M KEYNES DR UNIT 64
CHARLOTTE NC
28262-8408
US

V. Phone/Fax

Practice location:
  • Phone: 704-699-3347
  • Fax:
Mailing address:
  • Phone:
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAMEKA KNOTTS
Title or Position: MANAGER
Credential:
Phone: 704-699-3347