=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336468347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANOTHER LEVEL COUNSELING AND CONSULTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2010
-----------------------------------------------------
Last Update Date | 06/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1927 JN PEASE PL STE 104
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28262-4536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-548-5298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1927 JN PEASE PL STE 104
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28262-4536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SONYIA RICHARDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-548-5298
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 200600848
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------