Healthcare Provider Details

I. General information

NPI: 1437942042
Provider Name (Legal Business Name): UJIMA COMMUNITY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7504 E INDEPENDENCE BLVD STE 109
CHARLOTTE NC
28227-9454
US

IV. Provider business mailing address

1750 HIGHWAY 160 W STE 101-311
FORT MILL SC
29708-8009
US

V. Phone/Fax

Practice location:
  • Phone: 980-229-3824
  • Fax:
Mailing address:
  • Phone: 980-229-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM JASPER
Title or Position: MEMBER
Credential:
Phone: 980-229-3824