Healthcare Provider Details

I. General information

NPI: 1558088831
Provider Name (Legal Business Name): JOHN E. FLOYD MS, LCMHC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17714 KINGS POINT DR STE B
CORNELIUS NC
28031-6929
US

IV. Provider business mailing address

1561 WILLOW PARK DR APT 312
CHARLOTTE NC
28205-8977
US

V. Phone/Fax

Practice location:
  • Phone: 704-997-5397
  • Fax:
Mailing address:
  • Phone: 718-578-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18197
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: