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General NPI Number Information
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NPI Number | 1477173201
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Entity Type | Organization
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Legal Business Name | 3C WELLNESS, PLLC
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 9711 DAVID TAYLOR DR
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City | CHARLOTTE
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State | NC
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Zip | 28262-2366
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Country | US
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Telephone | 704-565-9578
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Fax |
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Provider Business Mailing Address
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Address Line | 11752 PRIDELAND CT
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City | CHARLOTTE
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State | NC
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Zip | 28273-4612
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Country | US
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Telephone | 704-713-9600
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Fax |
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Authorized Official
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Title or Position | OWNER / THERAPIST
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Name | ASHLEY SHAW
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Credential |
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Telephone | 704-713-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult 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 | 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 #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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