Healthcare Provider Details

I. General information

NPI: 1134378409
Provider Name (Legal Business Name): BALANCED CHOICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S MAIN ST SUITE 2B
DAVIDSON NC
28036-8096
US

IV. Provider business mailing address

PO BOX 1963
DAVIDSON NC
28036-1963
US

V. Phone/Fax

Practice location:
  • Phone: 704-655-2827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANNON ALISON HARTMAN WILSON
Title or Position: OWNER
Credential:
Phone: 704-655-2827