Healthcare Provider Details

I. General information

NPI: 1366309882
Provider Name (Legal Business Name): CHARLOTTE COUNSELING COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 MATTHEWS MINT HILL RD STE 108
MATTHEWS NC
28105-2894
US

IV. Provider business mailing address

7406 SPARKLEBERRY DR
INDIAN TRAIL NC
28079-9457
US

V. Phone/Fax

Practice location:
  • Phone: 980-500-9684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAVANNAH BRYANT
Title or Position: COUNSELOR
Credential:
Phone: 980-500-9684