Healthcare Provider Details

I. General information

NPI: 1396074159
Provider Name (Legal Business Name): CHILD & FAMILY THERAPY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 FAIRGROVE CHURCH RD SE SUITE 102
CONOVER NC
28613-9290
US

IV. Provider business mailing address

363 WILLIAMSON RD SUITE 102
MOORESVILLE NC
28117-5974
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-7148
  • Fax: 704-664-3086
Mailing address:
  • Phone: 704-664-7148
  • Fax: 704-664-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number851
License Number StateNC

VIII. Authorized Official

Name: MRS. PAMELA H JAMES
Title or Position: OFFICE MANAGER
Credential:
Phone: 704-664-7148