Provider Demographics
NPI:1114613908
Name:ALIGN MENTAL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:ALIGN MENTAL HEALTH & WELLNESS
Other - Org Name:I HAVE NO COMPANY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:704-578-8041
Mailing Address - Street 1:2936 CALDWELL RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5888
Mailing Address - Country:US
Mailing Address - Phone:704-578-8041
Mailing Address - Fax:
Practice Address - Street 1:3719 LATROBE DR STE 850H
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4827
Practice Address - Country:US
Practice Address - Phone:704-578-8041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty