Provider Demographics
NPI:1508553439
Name:DTA WELLNESS AND COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:DTA WELLNESS AND COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BEVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-999-4586
Mailing Address - Street 1:9311 JW CLAY BLVD STE A-106
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-5411
Mailing Address - Country:US
Mailing Address - Phone:980-352-8536
Mailing Address - Fax:
Practice Address - Street 1:9311 JW CLAY BLVD STE A-106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5411
Practice Address - Country:US
Practice Address - Phone:980-352-8536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty