Healthcare Provider Details

I. General information

NPI: 1427622158
Provider Name (Legal Business Name): JAVONNA BRESHEA HOPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PHIFER RD
KINGS MOUNTAIN NC
28086-3723
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-476-8330
  • Fax:
Mailing address:
  • Phone: 704-730-7003
  • Fax: 704-865-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023927
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: