Healthcare Provider Details

I. General information

NPI: 1043164361
Provider Name (Legal Business Name): THOUSAND BRANCHES PROFESSIONALS EAST COAST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 PARK RD STE 300
CHARLOTTE NC
28209-3790
US

IV. Provider business mailing address

4530 PARK RD STE 300
CHARLOTTE NC
28209-3790
US

V. Phone/Fax

Practice location:
  • Phone: 980-360-6100
  • Fax:
Mailing address:
  • Phone: 980-360-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-768-3300