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General NPI Number Information
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NPI Number | 1972291664
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Entity Type | Organization
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Legal Business Name | PEACEFUL AURA BEHAVIORAL HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 4801 E INDEPENDENCE BLVD STE 501
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City | CHARLOTTE
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State | NC
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Zip | 28212-5494
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Country | US
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Telephone | 704-388-6736
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Fax | 949-695-3608
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Provider Business Mailing Address
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Address Line | 4801 E INDEPENDENCE BLVD STE 501
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City | CHARLOTTE
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State | NC
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Zip | 28212-5494
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Country | US
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Telephone | 704-388-6736
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Fax | 949-695-3608
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Authorized Official
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Title or Position | CEO/DNP, PMHNP-BC
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Name | DR. DE'EDDA RENAE POWELL
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Credential | PMHNP-BC
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Telephone | 704-819-9079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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