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General NPI Number Information
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NPI Number | 1275788119
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Entity Type | Organization
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Legal Business Name | CHILD & FAMILY THERAPY CENTER, PC
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 363 WILLIAMSON RD SUITE 102
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City | MOORESVILLE
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State | NC
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Zip | 28117-5973
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Country | US
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Telephone | 704-664-7148
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Fax | 704-664-3086
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Provider Business Mailing Address
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Address Line | 363 WILLIAMSON RD SUITE 102
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City | MOORESVILLE
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State | NC
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Zip | 28117-5973
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Country | US
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Telephone | 704-664-7148
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Fax | 704-664-3086
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Authorized Official
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Title or Position | OWNER
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Name | MS. BETTY WRIGHT RUSSELL
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Credential | LCSW, LMFT, PHD
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Telephone | 704-664-7148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C000914
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License Number State | NC
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