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General NPI Number Information
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NPI Number | 1821908807
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Entity Type | Organization
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Legal Business Name | PROMISE PATH HOUSE
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 633 PENNWOOD LN
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City | CHARLOTTE
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State | NC
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Zip | 28215-2157
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Country | US
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Telephone | 704-589-4066
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Fax |
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Provider Business Mailing Address
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Address Line | 416 W KINGSTON AVE
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City | CHARLOTTE
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State | NC
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Zip | 28203-4433
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Country | US
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Telephone | 704-589-4066
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAQUITA JENNINGS
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Credential |
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Telephone | 704-589-4066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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