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General NPI Number Information
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NPI Number | 1134749633
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Entity Type | Organization
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Legal Business Name | NEW VISION THERAPY & WELLNESS, PLLC
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 11709 FRUEHAUF DR STE 124
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City | CHARLOTTE
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State | NC
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Zip | 28273-7286
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Country | US
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Telephone | 803-448-1590
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Fax |
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Provider Business Mailing Address
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Address Line | 747 HALL SPENCER RD
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City | CATAWBA
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State | SC
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Zip | 29704-9401
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Country | US
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Telephone | 803-448-1590
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Fax | 888-416-8540
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Authorized Official
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Title or Position | ORGANIZER
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Name | MRS. CANDICE MOFFATT
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Credential | LCMHC
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Telephone | 803-448-1590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 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 #3
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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