Provider Demographics
NPI:1720192107
Name:CHARLOTTE CENTER FOR BALANCED LIVING, P.A.
Entity Type:Organization
Organization Name:CHARLOTTE CENTER FOR BALANCED LIVING, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:704-378-1390
Mailing Address - Street 1:2125 SOUTHEND DR STE 452
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5088
Mailing Address - Country:US
Mailing Address - Phone:704-378-1390
Mailing Address - Fax:704-378-1392
Practice Address - Street 1:2125 SOUTHEND DR STE 252
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5081
Practice Address - Country:US
Practice Address - Phone:704-378-1390
Practice Address - Fax:704-378-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018C2OtherBCBS