Provider Demographics
NPI:1154678902
Name:CARDONA, JOSUE (LPCA, NCC)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:
Last Name:CARDONA
Suffix:
Gender:M
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-0247
Mailing Address - Country:US
Mailing Address - Phone:347-494-1102
Mailing Address - Fax:
Practice Address - Street 1:310 EAST BLVD STE 9D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4779
Practice Address - Country:US
Practice Address - Phone:704-565-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional