Provider Demographics
NPI:1265071542
Name:MY POSITIVE TRANSFORMATION
Entity type:Organization
Organization Name:MY POSITIVE TRANSFORMATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DILLON-SYMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-237-0881
Mailing Address - Street 1:6945 NORTHPARK BOULEVARD,
Mailing Address - Street 2:SUITE L DPT #6051
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216
Mailing Address - Country:US
Mailing Address - Phone:704-237-0881
Mailing Address - Fax:
Practice Address - Street 1:1935 J N PEASE PL STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4542
Practice Address - Country:US
Practice Address - Phone:704-237-0881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health