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5513 Monroe Rd Ste 205 Charlotte NC 28212-5503 | |
| (980) 433-7088 | |
| (984) 489-7334 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 5513 Monroe Rd Ste 205, Charlotte, North Carolina |
| Authorized Official Name and Position | Shareka Mingo (OWNER) |
| Authorized Official Contact | 9804337088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 433 Harrisburg NC 28075-0433 Ph: (980) 433-7088 | 5513 Monroe Rd Ste 205 Charlotte NC 28212-5503 Ph: (980) 433-7088 |
| NPI Number | 1801500541 |
|---|---|
| Provider Enumeration Date | 01/09/2023 |
| Last Update Date | 09/26/2024 |
| Certification Date | 09/25/2024 |
| Medicare PECOS PAC ID | 3375900210 |
|---|---|
| Medicare Enrollment ID | O20230607002789 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801500541 | NPI | - | NPPES |
| Provider Name | Razhedatequila Sanford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306374160 PECOS PAC ID: 2264874775 Enrollment ID: I20240530000384 |
| Provider Name | Selories Oglesby |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619318128 PECOS PAC ID: 7618415290 Enrollment ID: I20240814000732 |
| Provider Name | Melissa Covert |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437342623 PECOS PAC ID: 4587196092 Enrollment ID: I20241022000770 |
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