=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083356281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNAPOLOGETICALLY U COUNSELING & CONSULTING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2022
-----------------------------------------------------
Last Update Date | 06/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13936 DOVEHUNT PL
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28277-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-819-0768
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3540 TORINGDON WAY STE 200 UNIT #5033
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28277-4650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-819-0467
-----------------------------------------------------
Fax | 833-339-2796
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AMBER O PEARSON BOWEN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 704-819-0768
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------