Healthcare Provider Details

I. General information

NPI: 1265996490
Provider Name (Legal Business Name): EMOTIONAL WELLNESS & COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 CHARLOTTE HWY STE 203
LAKE WYLIE SC
29710-7062
US

IV. Provider business mailing address

510 MEADOW RIDGE DR
BELMONT NC
28012
US

V. Phone/Fax

Practice location:
  • Phone: 704-578-5904
  • Fax:
Mailing address:
  • Phone: 704-578-5904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATRINA REESE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LISW-CP, LCSW, MSW
Phone: 704-578-5904