Provider Demographics
NPI:1801527460
Name:828THERAPEUTICSERVICESPLLC
Entity type:Organization
Organization Name:828THERAPEUTICSERVICESPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SHENEQUA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-288-8840
Mailing Address - Street 1:7312 DULNIAN WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7908
Mailing Address - Country:US
Mailing Address - Phone:980-288-8840
Mailing Address - Fax:
Practice Address - Street 1:7312 DULNIAN WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7908
Practice Address - Country:US
Practice Address - Phone:980-613-3794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty