Healthcare Provider Details

I. General information

NPI: 1346965415
Provider Name (Legal Business Name): ROCINANTE HOLISTIC WELLNESS COUNSELING & RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S TRYON ST
CHARLOTTE NC
28281-0001
US

IV. Provider business mailing address

6302 CLEARWATER DR
INDIAN TRAIL NC
28079-8629
US

V. Phone/Fax

Practice location:
  • Phone: 704-226-7704
  • Fax:
Mailing address:
  • Phone: 990-339-1989
  • 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: MRS. JENNY STRICKLAND
Title or Position: CLINICAL DIRECTOR
Credential: MA
Phone: 828-339-1989