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General NPI Number Information
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NPI Number | 1417435710
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Entity Type | Organization
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Legal Business Name | PORCELAIN DOLLS OF THE CAROLINAS, INC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 5835 EXECUTIVE CENTER DR # 101-I
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City | CHARLOTTE
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State | NC
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Zip | 28212
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Country | US
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Telephone | 704-606-7824
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Fax |
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Provider Business Mailing Address
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Address Line | 13000 S TRYON ST # F-122
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City | CHARLOTTE
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State | NC
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Zip | 28278-7652
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Country | US
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Telephone | 704-951-5987
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Fax | 980-219-8444
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LISA M LEE
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Credential |
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Telephone | 704-951-5987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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