Provider Demographics
NPI:1164878880
Name:THE VILLAGE BEHAVIORAL HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:THE VILLAGE BEHAVIORAL HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHHALI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCAS, CCS
Authorized Official - Phone:704-891-3481
Mailing Address - Street 1:3126 MILTON RD STE 233
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3782
Mailing Address - Country:US
Mailing Address - Phone:704-891-3481
Mailing Address - Fax:855-299-3536
Practice Address - Street 1:3126 MILTON RD STE 233
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3782
Practice Address - Country:US
Practice Address - Phone:704-817-9117
Practice Address - Fax:855-299-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3040101YA0400X
NCC0099661041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty