Healthcare Provider Details

I. General information

NPI: 1821869470
Provider Name (Legal Business Name): EDUCATION SERVICE FOR EARLY INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 ROCKWOOD RD
CHARLOTTE NC
28216-2700
US

IV. Provider business mailing address

5200 ROCKWOOD RD
CHARLOTTE NC
28216-2700
US

V. Phone/Fax

Practice location:
  • Phone: 704-395-0352
  • Fax:
Mailing address:
  • Phone: 704-395-0352
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAKIA JACKSON SELLARS
Title or Position: OWNER/DIRECTOR
Credential: M.ED.
Phone: 704-219-6512