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General NPI Number Information
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NPI Number | 1972120558
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Entity Type | Organization
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Legal Business Name | WAYSTATION COUNSELING PLLC
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 4724 PARK RD STE A
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City | CHARLOTTE
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State | NC
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Zip | 28209-4204
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Country | US
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Telephone | 704-218-9083
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Fax | 980-237-7512
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Provider Business Mailing Address
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Address Line | 4724 PARK RD STE A
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City | CHARLOTTE
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State | NC
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Zip | 28209-4204
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Country | US
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Telephone | 704-218-9083
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Fax | 980-237-7512
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Authorized Official
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Title or Position | CFO
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Name | JULIE KORNOWSKI
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Credential |
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Telephone | 920-360-0116
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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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