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General NPI Number Information
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NPI Number | 1598221236
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Entity Type | Organization
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Legal Business Name | COUNSELING AND WELLNESS CENTER OF LAKE NORMAN, PLLC
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 18117 W CATAWBA AVE STE 3
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City | CORNELIUS
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State | NC
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Zip | 28031-5641
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Country | US
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Telephone | 828-263-4054
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Fax | 704-830-0465
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Provider Business Mailing Address
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Address Line | 9215 TORRENCE CROSSING DR
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-8134
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Country | US
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Telephone | 828-406-2828
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Fax | 704-830-0465
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Authorized Official
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Title or Position | OWNER/ORGANIZER
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Name | BRITTNAI WASHBURN
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Credential | LMFT
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Telephone | 828-406-2828
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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