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General NPI Number Information
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NPI Number | 1548796766
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Entity Type | Organization
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Legal Business Name | CHARLOTTE COUNSELING AND CONSULTING, PLLC
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Dates
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Enumeration Date | 05/08/2017
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 1905 J N PEASE PL STE 202
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City | CHARLOTTE
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State | NC
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Zip | 28262-4539
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Country | US
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Telephone | 704-771-4633
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Fax | 980-225-5555
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Provider Business Mailing Address
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Address Line | 1905 J N PEASE PL
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City | CHARLOTTE
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State | NC
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Zip | 28262-4557
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Country | US
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Telephone | 704-771-4633
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Fax | 980-225-5555
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Authorized Official
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Title or Position | OWNER
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Name | JAMARR FUNDERBURG
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Credential | LICSW
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Telephone | 704-771-4633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10648
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 10648
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License Number State | SC
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