Healthcare Provider Details

I. General information

NPI: 1881316891
Provider Name (Legal Business Name): GATEWAY CHARLOTTE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8936 NORTHPOINTE EXECUTIVE PARK DRIVE SUITE 240/260
HUNTERSVILLE NC
28078
US

IV. Provider business mailing address

8936 NORTHPOINTE EXECUTIVE PARK DRIVE SUITE 240/260
HUNTERSVILLE NC
28078
US

V. Phone/Fax

Practice location:
  • Phone: 980-236-9244
  • Fax:
Mailing address:
  • Phone: 980-236-9244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUCINDA OKYERE AGBEWALI
Title or Position: NURSE PRACTITIONER
Credential: DNP, FNP-C,PMHNP-BC
Phone: 980-236-9244