Provider Demographics
NPI:1316767346
Name:THE CIRCLE A MENTAL HEALTH AND WELLNESS COLLECTIVE, PLLC
Entity type:Organization
Organization Name:THE CIRCLE A MENTAL HEALTH AND WELLNESS COLLECTIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:LARCHELLE
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:501-256-2885
Mailing Address - Street 1:1235 EAST BLVD STE E1215
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5870
Mailing Address - Country:US
Mailing Address - Phone:980-281-1784
Mailing Address - Fax:
Practice Address - Street 1:1235 EAST BLVD STE E1215
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5870
Practice Address - Country:US
Practice Address - Phone:980-281-1784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty