Provider Demographics
NPI:1477988202
Name:WOMENS TRANSITIONAL HEALTHCARE PLLC
Entity Type:Organization
Organization Name:WOMENS TRANSITIONAL HEALTHCARE PLLC
Other - Org Name:WOMEN'S TRANSITIONAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:GRAVES
Authorized Official - Last Name:SUFFREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-817-8230
Mailing Address - Street 1:1977 J N PEASE PL STE 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4527
Mailing Address - Country:US
Mailing Address - Phone:704-817-8230
Mailing Address - Fax:704-665-5645
Practice Address - Street 1:1977 J N PEASE PL STE 203
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4527
Practice Address - Country:US
Practice Address - Phone:704-817-8230
Practice Address - Fax:704-665-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC188505261QM0801X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)