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General NPI Number Information
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NPI Number | 1457768988
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Entity Type | Organization
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Legal Business Name | LIFE FLOW YOUTH & FAMILY COUNSELING
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 11300 WALLAND LN
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City | CHARLOTTE
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State | NC
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Zip | 28273-4596
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Country | US
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Telephone | 704-454-8027
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Fax |
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Provider Business Mailing Address
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Address Line | 11300 WALLAND LANE
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City | CHARLOTTE
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State | NC
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Zip | 28273
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Country | US
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Telephone | 704-454-8027
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUNSHURAE L BURRIS
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Credential |
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Telephone | 704-454-8027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | NC
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