Provider Demographics
NPI:1669749644
Name:CHARLOTTE FAMILY COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:CHARLOTTE FAMILY COUNSELING CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA; LCSW; BCBA
Authorized Official - Phone:704-236-9390
Mailing Address - Street 1:1362 SECRET PATH DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6545
Mailing Address - Country:US
Mailing Address - Phone:704-236-9390
Mailing Address - Fax:803-693-0701
Practice Address - Street 1:1101 TYVOLA RD
Practice Address - Street 2:STE 304
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3515
Practice Address - Country:US
Practice Address - Phone:704-236-9390
Practice Address - Fax:803-693-0701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTE FAMILY COUNSELING CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9585251S00000X
NCC006890251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health