Healthcare Provider Details

I. General information

NPI: 1912287459
Provider Name (Legal Business Name): BUTTERFLY EFFECTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 08/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 DALLAS AVE
CHARLOTTE NC
28205-7905
US

IV. Provider business mailing address

PO BOX 6059
FARGO ND
58108-6059
US

V. Phone/Fax

Practice location:
  • Phone: 180-069-2232
  • Fax: 800-465-3203
Mailing address:
  • Phone: 180-069-2232
  • Fax: 800-465-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. WANDA M
Title or Position: SUPERVISION
Credential:
Phone: 704-493-6621