Provider Demographics
NPI:1396316089
Name:EMBRACE CHABAQ MINISTRIES
Entity type:Organization
Organization Name:EMBRACE CHABAQ MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:704-281-4424
Mailing Address - Street 1:8307 UNIVERSITY EXEC PARK DR STE 242
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1374
Mailing Address - Country:US
Mailing Address - Phone:704-900-5560
Mailing Address - Fax:
Practice Address - Street 1:8307 UNIVERSITY EXEC PARK DR STE 242
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1374
Practice Address - Country:US
Practice Address - Phone:704-900-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386878601OtherNPI