=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083563274
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROJECT MIRROR COUNSELING & OUTREACH SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2026
-----------------------------------------------------
Last Update Date | 01/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5540 FRANKLIN SPRINGS CIR
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28217-2097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-833-9823
-----------------------------------------------------
Fax | 203-833-9823
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5540 FRANKLIN SPRINGS CIR
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28217-2097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-833-9823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAMONT DIXON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-833-9823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------