Healthcare Provider Details

I. General information

NPI: 1609744671
Provider Name (Legal Business Name): CHARLES SALTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 OLD TAR RD STE F
WINTERVILLE NC
28590-9856
US

IV. Provider business mailing address

6000 OLD TAR RD
WINTERVILLE NC
28590-7782
US

V. Phone/Fax

Practice location:
  • Phone: 252-917-1032
  • Fax:
Mailing address:
  • Phone: 252-917-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES SALTER
Title or Position: OWNER
Credential:
Phone: 252-917-1032