Healthcare Provider Details

I. General information

NPI: 1346902426
Provider Name (Legal Business Name): R3 COUNSELING & COACHING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MATTHEWS MINT HILL RD STE 210
MATTHEWS NC
28105-0004
US

IV. Provider business mailing address

6303 HOLLY KNOLL DR
CHARLOTTE NC
28227-2429
US

V. Phone/Fax

Practice location:
  • Phone: 704-350-5837
  • Fax:
Mailing address:
  • Phone: 704-350-5837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAYONA FRAYLON
Title or Position: OWNER
Credential:
Phone: 704-350-5837