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General NPI Number Information
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NPI Number | 1396223160
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Entity Type | Organization
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Legal Business Name | BALANCED MINDSET COUNSELING AND PSYCHOLOGICAL SVCS, PLLC
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 10130 MALLARD CREEK RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28262-6001
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Country | US
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Telephone | 704-944-3572
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Fax | 704-944-3101
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Provider Business Mailing Address
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Address Line | 10130 MALLARD CREEK RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28262-6001
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Country | US
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Telephone | 704-944-3572
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Fax | 704-944-3101
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Authorized Official
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Title or Position | OWNER
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Name | DR. GENE R. EDWARDS
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Credential | PH.D.
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Telephone | 704-944-3572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3660
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License Number State | NC
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