Healthcare Provider Details

I. General information

NPI: 1215693445
Provider Name (Legal Business Name): AVID WELLNESS COUNSELING AND CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COPPERFIELD BLVD NE STE 112B
CONCORD NC
28025-2454
US

IV. Provider business mailing address

1000 COPPERFIELD BLVD NE STE 112
CONCORD NC
28025-2454
US

V. Phone/Fax

Practice location:
  • Phone: 704-236-4067
  • Fax: 704-445-4582
Mailing address:
  • Phone: 704-236-4067
  • Fax: 704-445-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VERA MILLNER
Title or Position: OWNER
Credential:
Phone: 704-236-4067