Provider Demographics
NPI:1972881662
Name:A JOURNEY INTO WHOLENESS COUNSELING AND MENTORING SERVICE LLC
Entity type:Organization
Organization Name:A JOURNEY INTO WHOLENESS COUNSELING AND MENTORING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:KEITT
Authorized Official - Suffix:
Authorized Official - Credentials:MEMBER
Authorized Official - Phone:1800-641-6796
Mailing Address - Street 1:PO BOX 681532
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0027
Mailing Address - Country:US
Mailing Address - Phone:180-064-1679
Mailing Address - Fax:704-900-7978
Practice Address - Street 1:1910 DOUBLE CEDAR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-1474
Practice Address - Country:US
Practice Address - Phone:180-064-1679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty