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General NPI Number Information
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NPI Number | 1255808036
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIVE VISION
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 227 W 4TH ST STE 321
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City | CHARLOTTE
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State | NC
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Zip | 28202-1545
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Country | US
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Telephone | 704-879-1179
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Fax |
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Provider Business Mailing Address
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Address Line | 227 W 4TH ST STE 321
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City | CHARLOTTE
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State | NC
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Zip | 28202-1545
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | JACQUELINE BREWINGTON
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Credential | LMFT, BC-TMH
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Telephone | 704-879-1179
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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 | 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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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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