Healthcare Provider Details

I. General information

NPI: 1053934356
Provider Name (Legal Business Name): NEW HEIGHTS BEHAVIORAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 JEAN GRIMES DR. #304
CHARLOTTE NC
28269-3061
US

IV. Provider business mailing address

4929 JEAN GRIMES DR. #304
CHARLOTTE NC
28269-3061
US

V. Phone/Fax

Practice location:
  • Phone: 704-641-7475
  • Fax:
Mailing address:
  • Phone: 704-641-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. TAWANDA BOSTIC
Title or Position: OWNER
Credential: NP
Phone: 704-641-7475