=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235757147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFTER THE STORM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2020
-----------------------------------------------------
Last Update Date | 07/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 DAVIE AVE
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28677-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-883-2704
-----------------------------------------------------
Fax | 704-498-4078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 SILCHESTER LN
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28215-5300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-883-2704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. PATRICIA PARONETT-BALLARD
-----------------------------------------------------
Credential | LCMHC
-----------------------------------------------------
Telephone | 704-883-2704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------