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General NPI Number Information
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NPI Number | 1154146207
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Entity Type | Organization
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Legal Business Name | VITALITY WELLNESS COUNSELING & CLINICAL SERVICES PLLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 564 ASHE WAY
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City | KERNERSVILLE
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State | NC
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Zip | 27284-6976
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Country | US
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Telephone | 336-517-6427
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Fax |
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Provider Business Mailing Address
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Address Line | 10926 DAVID TAYLOR DR STE 120
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City | CHARLOTTE
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State | NC
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Zip | 28262-0039
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Country | US
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Telephone | 336-517-6427
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | TIONNA BRICE
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Credential |
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Telephone | 336-517-6427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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