Healthcare Provider Details

I. General information

NPI: 1528390168
Provider Name (Legal Business Name): 7 DEGREE'S OF CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 ROSE TERRACE CT
CHARLOTTE NC
28215
US

IV. Provider business mailing address

7220 ROSE TERRACE CT
CHARLOTTE NC
28215-3671
US

V. Phone/Fax

Practice location:
  • Phone: 980-226-1493
  • Fax:
Mailing address:
  • Phone: 980-226-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NICHELLE F DICKERSON
Title or Position: BUSINESS ADMINSTRATOR/COUNSELOR
Credential:
Phone: 704-449-3892