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General NPI Number Information
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NPI Number | 1174203137
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS INTEGRATIVE WELLNESS, PLLC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 108 GATEWAY BLVD STE 207
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City | MOORESVILLE
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State | NC
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Zip | 28117-5597
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Country | US
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Telephone | 980-222-1056
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Fax |
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Provider Business Mailing Address
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Address Line | 108 GATEWAY BLVD STE 207
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City | MOORESVILLE
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State | NC
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Zip | 28117-5597
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Country | US
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Telephone | 980-222-1056
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | ADAM KURTZ
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Credential | LCMHC
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Telephone | 980-288-2974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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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