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General NPI Number Information
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NPI Number | 1669833729
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Entity Type | Organization
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Legal Business Name | HEAVENLY GATES RELAXATION LLC
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 8539 MONROE RD SUITE 125
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City | CHARLOTTE
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State | NC
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Zip | 28212-7510
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Country | US
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Telephone | 704-337-9556
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Fax |
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Provider Business Mailing Address
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Address Line | 8539 MONROE RD SUITE 125
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City | CHARLOTTE
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State | NC
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Zip | 28212-7510
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Country | US
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Telephone | 704-337-9556
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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 | MRS. ANDREA V. RANKIN
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Credential | LMTB
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Telephone | 980-337-9556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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