Provider Demographics
NPI:1578148011
Name:LOTUS HOLISTIC THERAPY CENTER PLLC
Entity Type:Organization
Organization Name:LOTUS HOLISTIC THERAPY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TIA
Authorized Official - Middle Name:DAMALI
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:980-202-1306
Mailing Address - Street 1:801 EAST MOREHEAD STREET SUITE 105
Mailing Address - Street 2:#3138
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202
Mailing Address - Country:US
Mailing Address - Phone:980-202-1306
Mailing Address - Fax:
Practice Address - Street 1:801 EAST MOREHEAD STREET SUITE 105
Practice Address - Street 2:#3138
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202
Practice Address - Country:US
Practice Address - Phone:980-202-1306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty