Provider Demographics
NPI:1023635851
Name:CHARLOTTE WOMEN'S COUNSELING
Entity type:Organization
Organization Name:CHARLOTTE WOMEN'S COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCHMC
Authorized Official - Phone:704-313-3088
Mailing Address - Street 1:322 LAMAR AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2436
Mailing Address - Country:US
Mailing Address - Phone:704-313-3088
Mailing Address - Fax:704-313-3088
Practice Address - Street 1:322 LAMAR AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2436
Practice Address - Country:US
Practice Address - Phone:704-313-3088
Practice Address - Fax:704-313-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health