Healthcare Provider Details

I. General information

NPI: 1427770684
Provider Name (Legal Business Name): ENLIGHTENED COUNSELING AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S MAIN ST STE 7
KANNAPOLIS NC
28081-4915
US

IV. Provider business mailing address

701 SPENCER LN
KANNAPOLIS NC
28081-0012
US

V. Phone/Fax

Practice location:
  • Phone: 704-269-8773
  • Fax:
Mailing address:
  • Phone: 704-224-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. HALBREONDA MCNEILL HOLLOWAY
Title or Position: MEMBER/ ORGANIZER
Credential: LCSW
Phone: 704-224-3077