Healthcare Provider Details

I. General information

NPI: 1477129856
Provider Name (Legal Business Name): COSMO THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 CAMBRIDGE HEIGHTS PL NW
CONCORD NC
28027-8673
US

IV. Provider business mailing address

1560 CAMBRIDGE HEIGHTS PL NW
CONCORD NC
28027-8673
US

V. Phone/Fax

Practice location:
  • Phone: 980-289-7475
  • Fax:
Mailing address:
  • Phone: 225-303-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: SONYA N WARREN
Title or Position: THERAPIST
Credential: LCMHC
Phone: 980-289-7475