Healthcare Provider Details

I. General information

NPI: 1356016414
Provider Name (Legal Business Name): KARLEY SOMERVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 ST JOHN RD
FLETCHER NC
28732-8334
US

IV. Provider business mailing address

814 TYVOLA RD STE 116
CHARLOTTE NC
28217-4598
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax: 980-785-1114
Mailing address:
  • Phone: 980-785-1113
  • Fax: 980-785-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67049
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: