Healthcare Provider Details

I. General information

NPI: 1033029079
Provider Name (Legal Business Name): AV PROACTIVE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 W ARBORS DR STE 200
CHARLOTTE NC
28262-2698
US

IV. Provider business mailing address

2315 W ARBORS DR STE 200
CHARLOTTE NC
28262-2698
US

V. Phone/Fax

Practice location:
  • Phone: 336-263-5577
  • Fax:
Mailing address:
  • Phone: 336-263-5577
  • Fax: 704-519-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAKISHA ANDERSON HIGHE
Title or Position: OWNER
Credential: AGNP-C
Phone: 336-263-5577