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General NPI Number Information
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NPI Number | 1306359153
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Entity Type | Organization
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Legal Business Name | BLUE SAGE COUNSELING AND WELLNESS, PLLC
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 5200 PARK RD STE 229
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City | CHARLOTTE
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State | NC
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Zip | 28209-3651
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Country | US
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Telephone | 704-778-6141
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 PARK RD STE 229
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City | CHARLOTTE
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State | NC
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Zip | 28209-3651
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Country | US
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Telephone | 704-778-6141
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Fax |
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Authorized Official
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Title or Position | LICENSED MARRIAGE AND FAMILY THERAP
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Name | ASHLEY FRANCIS
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Credential | MS, LMFT, LPCA
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Telephone | 704-778-6141
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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 | A10010
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1663
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License Number State | NC
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