Provider Demographics
NPI:1659941359
Name:BEYOND THE MASK TRAUMA AND WELLNESS PLLC
Entity Type:Organization
Organization Name:BEYOND THE MASK TRAUMA AND WELLNESS PLLC
Other - Org Name:BEYOND THE MASK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-741-0919
Mailing Address - Street 1:11424 SWEETBRIAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5046
Mailing Address - Country:US
Mailing Address - Phone:704-741-0919
Mailing Address - Fax:980-422-0267
Practice Address - Street 1:7200 E WT HARRIS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7200
Practice Address - Country:US
Practice Address - Phone:443-744-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-26
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)