Provider Demographics
NPI:1942905575
Name:QUEEN CITY WELLNESS COLLECTIVE
Entity Type:Organization
Organization Name:QUEEN CITY WELLNESS COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:MACARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-562-8717
Mailing Address - Street 1:6424 CAMERON FOREST LN APT 1B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-5055
Mailing Address - Country:US
Mailing Address - Phone:704-562-8717
Mailing Address - Fax:
Practice Address - Street 1:6115 PARK SOUTH DR STE 135
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3269
Practice Address - Country:US
Practice Address - Phone:704-562-8717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)