Provider Demographics
NPI:1881194249
Name:BALANCE NC, LLC
Entity Type:Organization
Organization Name:BALANCE NC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, BCBA
Authorized Official - Phone:704-200-9355
Mailing Address - Street 1:1927 N SHARON AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7921
Mailing Address - Country:US
Mailing Address - Phone:704-200-9355
Mailing Address - Fax:
Practice Address - Street 1:1927 N SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7921
Practice Address - Country:US
Practice Address - Phone:704-200-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12854101YP2500X
1-17-24973103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty