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NPI Code Detail

MEDICARE: POLARIS COUNSELING CENTER PLLC

MEDICARE: POLARIS COUNSELING CENTER PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1417648239
Entity Type Code : Organization
Provider Name (Legal Business Name) : POLARIS COUNSELING CENTER PLLC
Provider Business Mailing Address
First Line : 3957 ERSKINE WOODS DR
Second Line :
City : BESSEMER CITY
State : NC
Zip : 28016-6556
Country : US
Telephone Number : 704-476-5204
Fax Number :
Provider Business Practice Location Address
First Line : 11709 FRUEHAUF DR # 0
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-7284
Country : US
Telephone Number : 980-396-2870
Fax Number :
Authorized Official
Title or Position : CEO
Name : ROBERT COSTA LODWICK
Credential : LCMHC
Telephone Number : 704-476-5204
Provider Enumeration Date : 05/15/2023
Last Update Date : 05/15/2023

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Directions to “POLARIS COUNSELING CENTER PLLC ” Practice Location

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