Provider Demographics
NPI:1780282715
Name:LAKE NORMAN MIND AND BODY CONNECTION PLLC
Entity type:Organization
Organization Name:LAKE NORMAN MIND AND BODY CONNECTION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC
Authorized Official - Phone:704-396-4287
Mailing Address - Street 1:16507 NORTHCROSS DR STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5082
Mailing Address - Country:US
Mailing Address - Phone:704-396-4287
Mailing Address - Fax:
Practice Address - Street 1:16507 NORTHCROSS DR STE C
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5082
Practice Address - Country:US
Practice Address - Phone:704-396-4287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty