Healthcare Provider Details

I. General information

NPI: 1134043938
Provider Name (Legal Business Name): NJERI TOLLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 ROSE LAKE DR STE E
CHARLOTTE NC
28217-2864
US

IV. Provider business mailing address

4111 ROSE LAKE DR STE E
CHARLOTTE NC
28217-2864
US

V. Phone/Fax

Practice location:
  • Phone: 336-682-0876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: