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General NPI Number Information
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NPI Number | 1417648239
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Entity Type | Organization
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Legal Business Name | POLARIS COUNSELING CENTER PLLC
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 11709 FRUEHAUF DR # 0
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City | CHARLOTTE
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State | NC
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Zip | 28273-7284
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Country | US
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Telephone | 980-396-2870
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Fax |
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Provider Business Mailing Address
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Address Line | 3957 ERSKINE WOODS DR
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City | BESSEMER CITY
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State | NC
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Zip | 28016-6556
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Country | US
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Telephone | 704-476-5204
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT COSTA LODWICK
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Credential | LCMHC
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Telephone | 704-476-5204
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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 |
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License Number State |
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