| Dta Wellness And Counseling Services, Pllc | |
|
9311 Jw Clay Blvd Ste A-106 Charlotte NC 28262-5411 | |
| (980) 352-8536 | |
| Not Available |
| Full Name | Dta Wellness And Counseling Services, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 9311 Jw Clay Blvd Ste A-106, Charlotte, North Carolina |
| Authorized Official Name and Position | Sonia Diane Beverly (OWNER) |
| Authorized Official Contact | 7049994586 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dta Wellness And Counseling Services, Pllc 9311 Jw Clay Blvd Ste A-106 Charlotte NC 28262-5411 Ph: (980) 352-8536 | Dta Wellness And Counseling Services, Pllc 9311 Jw Clay Blvd Ste A-106 Charlotte NC 28262-5411 Ph: (980) 352-8536 |
| NPI Number | 1508553439 |
|---|---|
| Provider Enumeration Date | 04/20/2023 |
| Last Update Date | 04/20/2023 |
| Certification Date | 04/20/2023 |
| Medicare PECOS PAC ID | 4688116031 |
|---|---|
| Medicare Enrollment ID | O20240613000075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508553439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Sonia Diane Beverly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992221600 PECOS PAC ID: 5597207944 Enrollment ID: I20240613000093 |
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