Healthcare Provider Details

I. General information

NPI: 1730894676
Provider Name (Legal Business Name): WESLEY BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MCCULLOUGH DR STE 380
CHARLOTTE NC
28262-1370
US

IV. Provider business mailing address

201 MCCULLOUGH DR STE 380
CHARLOTTE NC
28262-1370
US

V. Phone/Fax

Practice location:
  • Phone: 980-355-3737
  • Fax:
Mailing address:
  • Phone: 980-355-3737
  • Fax: 980-422-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NATIELA STUCKES
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 980-355-3737