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General NPI Number Information
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NPI Number | 1205515566
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Entity Type | Organization
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Legal Business Name | ASCENTIA MIND AND BODY WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 1914 J N PEASE PL STE 180&182
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City | CHARLOTTE
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State | NC
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Zip | 28262-4504
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Country | US
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Telephone | 704-909-0302
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Fax | 704-772-1774
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Provider Business Mailing Address
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Address Line | 1914 J N PEASE PL STE 180&182
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City | CHARLOTTE
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State | NC
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Zip | 28262-4504
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Country | US
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Telephone | 704-909-0302
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Fax | 704-772-1774
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | CLAUDETTE A GREEN
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Credential | DNP PMHNP-BC
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Telephone | 704-909-0304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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