Provider Demographics
NPI:1568822575
Name:MASTERPEACE COUNSELING AND DEVELOPMENT CENTER LLC
Entity Type:Organization
Organization Name:MASTERPEACE COUNSELING AND DEVELOPMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA
Authorized Official - Phone:704-221-1184
Mailing Address - Street 1:3260 BARONS COURT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4867
Mailing Address - Country:US
Mailing Address - Phone:704-221-1184
Mailing Address - Fax:
Practice Address - Street 1:3260 BARONS COURT RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4867
Practice Address - Country:US
Practice Address - Phone:704-221-1184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NCA11480251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management