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General NPI Number Information
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NPI Number | 1720588783
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Entity Type | Individual
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Provider Name | ANN CLAY CHURCH MA
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Gender | Female
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 7804 FAIRVIEW RD STE C288
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City | CHARLOTTE
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State | NC
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Zip | 28226-4998
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Country | US
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Telephone | 980-285-3952
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Fax |
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Provider Business Mailing Address
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Address Line | 7804 FAIRVIEW RD STE C288
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City | CHARLOTTE
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State | NC
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Zip | 28226-4998
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Country | US
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Telephone | 980-295-3952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A12542
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License Number State | NC
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