Healthcare Provider Details

I. General information

NPI: 1194017285
Provider Name (Legal Business Name): CHRISTINE LOUCY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE DEE

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date: 05/07/2026
Reactivation Date: 06/24/2026

III. Provider practice location address

211 W MATTHEWS ST STE 106
MATTHEWS NC
28105-1310
US

IV. Provider business mailing address

1106 CLOVER LN
MATTHEWS NC
28104-6120
US

V. Phone/Fax

Practice location:
  • Phone: 704-846-0262
  • Fax:
Mailing address:
  • Phone: 704-371-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9574
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: