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General NPI Number Information
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NPI Number | 1972881662
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Entity Type | Organization
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Legal Business Name | A JOURNEY INTO WHOLENESS COUNSELING AND MENTORING SERVICE LLC
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 1910 DOUBLE CEDAR DR
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City | CHARLOTTE
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State | NC
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Zip | 28214-1474
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Country | US
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Telephone | 180-064-1679
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 681532
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City | CHARLOTTE
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State | NC
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Zip | 28216-0027
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Country | US
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Telephone | 180-064-1679
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Fax | 704-900-7978
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. CHARLENE NEAL KEITT
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Credential | MEMBER
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Telephone | 18006416796
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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 |
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License Number State |
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