Provider Demographics
NPI:1881316891
Name:GATEWAY CHARLOTTE WELLNESS
Entity type:Organization
Organization Name:GATEWAY CHARLOTTE WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:OKYERE
Authorized Official - Last Name:AGBEWALI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C,PMHNP-BC
Authorized Official - Phone:980-236-9244
Mailing Address - Street 1:8936 NORTHPOINTE EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 240/260
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078
Mailing Address - Country:US
Mailing Address - Phone:980-236-9244
Mailing Address - Fax:
Practice Address - Street 1:8936 NORTHPOINTE EXECUTIVE PARK DRIVE
Practice Address - Street 2:SUITE 240/260
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:980-236-9244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty