Provider Demographics
NPI:1598221236
Name:COUNSELING AND WELLNESS CENTER OF LAKE NORMAN, PLLC
Entity Type:Organization
Organization Name:COUNSELING AND WELLNESS CENTER OF LAKE NORMAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNAI
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:828-406-2828
Mailing Address - Street 1:9215 TORRENCE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8134
Mailing Address - Country:US
Mailing Address - Phone:828-406-2828
Mailing Address - Fax:704-830-0465
Practice Address - Street 1:18117 W CATAWBA AVE STE 3
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5641
Practice Address - Country:US
Practice Address - Phone:828-263-4054
Practice Address - Fax:704-830-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty