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General NPI Number Information
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NPI Number | 1114502242
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Entity Type | Organization
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Legal Business Name | CAROLINAS PROFESSIONAL COUNSELING & CONSULTING, PLLC
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 10130 MALLARD CREEK RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28262-6001
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Country | US
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Telephone | 704-497-2633
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Fax | 704-625-9084
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Provider Business Mailing Address
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Address Line | 10130 MALLARD CREEK RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28262-6001
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Country | US
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Telephone | 980-439-2672
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Fax | 704-625-9084
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Authorized Official
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Title or Position | LICENSED COUNSELOR/PRACTICE OWNER
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Name | SHELLY H SANDERS
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Credential | LCMHC
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Telephone | 980-439-2672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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