Provider Demographics
NPI:1033843073
Name:MOMMY 2 MOMMY LLC
Entity Type:Organization
Organization Name:MOMMY 2 MOMMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FULWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-891-6883
Mailing Address - Street 1:8036 MCGARRY TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-7649
Mailing Address - Country:US
Mailing Address - Phone:704-891-6883
Mailing Address - Fax:
Practice Address - Street 1:120 MACEY BLVD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1343
Practice Address - Country:US
Practice Address - Phone:704-891-6883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health