Provider Demographics
NPI:1487482352
Name:M&M PURPLE HEART WELLNESS
Entity type:Organization
Organization Name:M&M PURPLE HEART WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARRON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, QP, CPSS
Authorized Official - Phone:980-439-1878
Mailing Address - Street 1:2000 WOODHAVEN DR APT 321
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-1107
Mailing Address - Country:US
Mailing Address - Phone:980-439-1878
Mailing Address - Fax:
Practice Address - Street 1:251 OAK ST
Practice Address - Street 2:
Practice Address - City:STANFIELD
Practice Address - State:NC
Practice Address - Zip Code:28163-6708
Practice Address - Country:US
Practice Address - Phone:704-635-1162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty