Provider Demographics
NPI:1679128409
Name:THE FACTS INITIATIVE
Entity Type:Organization
Organization Name:THE FACTS INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:DIONE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCA, NCC
Authorized Official - Phone:309-706-9336
Mailing Address - Street 1:1341 E MOREHEAD ST STE 202-B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2937
Mailing Address - Country:US
Mailing Address - Phone:704-251-2481
Mailing Address - Fax:
Practice Address - Street 1:1341 E MOREHEAD ST STE 202-B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2937
Practice Address - Country:US
Practice Address - Phone:704-251-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty