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General NPI Number Information
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NPI Number | 1396074159
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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 | 12/08/2009
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 715 FAIRGROVE CHURCH RD SE SUITE 102
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City | CONOVER
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State | NC
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Zip | 28613-9290
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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 | 28117-5974
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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 | OFFICE MANAGER
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Name | MRS. PAMELA H JAMES
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Credential |
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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 | 851
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License Number State | NC
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