Healthcare Provider Details

I. General information

NPI: 1679931612
Provider Name (Legal Business Name): APRIL BROADWATER POMERLYAN MAED, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6824 WILSON GROVE RD
MINT HILL NC
28227-4239
US

IV. Provider business mailing address

6824 WILSON GROVE RD
MINT HILL NC
28227-4239
US

V. Phone/Fax

Practice location:
  • Phone: 980-290-4752
  • Fax:
Mailing address:
  • Phone: 704-849-0144
  • Fax: 704-845-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11996
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11996
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: