Provider Demographics
NPI:1245999523
Name:AGAPE HEALING AND WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:AGAPE HEALING AND WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARNITA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:313-909-0539
Mailing Address - Street 1:1913 J N PEASE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4537
Mailing Address - Country:US
Mailing Address - Phone:919-807-1692
Mailing Address - Fax:
Practice Address - Street 1:1913 J N PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4537
Practice Address - Country:US
Practice Address - Phone:919-807-1692
Practice Address - Fax:833-980-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1356796809Other1356796809