Healthcare Provider Details

I. General information

NPI: 1396247755
Provider Name (Legal Business Name): INSPIRATION SERVICES FOR CHILDREN & FAMILIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 TYVOLA RD OFC 320
CHARLOTTE NC
28217-3515
US

IV. Provider business mailing address

8331 RIVERBIRCH DR APT 304
CHARLOTTE NC
28210-5994
US

V. Phone/Fax

Practice location:
  • Phone: 980-292-1855
  • Fax:
Mailing address:
  • Phone: 917-518-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberP011890
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberP011890
License Number StateNC

VIII. Authorized Official

Name: ADENIA PEREZ LOPEZ
Title or Position: SOCIAL WORKER
Credential: LCSWA
Phone: 980-292-1855