Healthcare Provider Details

I. General information

NPI: 1083576136
Provider Name (Legal Business Name): PIEDMONT WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UNION ST S STE LL209
CONCORD NC
28025-5059
US

IV. Provider business mailing address

11 UNION ST S STE LL209
CONCORD NC
28025-5059
US

V. Phone/Fax

Practice location:
  • Phone: 919-672-5005
  • Fax:
Mailing address:
  • Phone: 919-672-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. DASHUN TYRELL BANKS
Title or Position: CEO
Credential:
Phone: 919-672-5005