Provider Demographics
NPI:1639760499
Name:COGNITIVE FOOTPRINTS, INC
Entity type:Organization
Organization Name:COGNITIVE FOOTPRINTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-919-0161
Mailing Address - Street 1:RESIDENCE
Mailing Address - Street 2:7715 ARAGORN LANE
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212
Mailing Address - Country:US
Mailing Address - Phone:910-726-5252
Mailing Address - Fax:
Practice Address - Street 1:RESIDENCE
Practice Address - Street 2:7715 ARAGORN LANE
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212
Practice Address - Country:US
Practice Address - Phone:910-726-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty