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NPI Code Detail

MEDICARE: HEARTWOOD PERFORMANCE, PLLC

MEDICARE: HEARTWOOD PERFORMANCE, 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
11041C0700XClinical Social WorkerC010390NC

General Provider Information

NPI Number : 1598250300
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEARTWOOD PERFORMANCE, PLLC
Provider Business Mailing Address
First Line : 15720 BRIXHAM HILL AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-4651
Country : US
Telephone Number : 704-476-5575
Fax Number :
Provider Business Practice Location Address
First Line : 5960 FAIRVIEW RD STE 400
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3119
Country : US
Telephone Number : 704-476-5575
Fax Number :
Authorized Official
Title or Position : OWNER
Name : BENJAMIN FOODMAN
Credential : LSCW
Telephone Number : 704-418-1333
Provider Enumeration Date : 06/25/2018
Last Update Date : 09/13/2021

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Directions to “HEARTWOOD PERFORMANCE, PLLC ” Practice Location

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