| Conversion Therapeutic Services Inc | |
|
11535 Carmel Commons Blvd Ste 102 Charlotte NC 28226-5314 | |
| (704) 910-1788 | |
| Not Available |
| Full Name | Conversion Therapeutic Services Inc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 11535 Carmel Commons Blvd Ste 102, Charlotte, North Carolina |
| Authorized Official Name and Position | Tenicia Washington (OWNER) |
| Authorized Official Contact | 4435311988 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Conversion Therapeutic Services Inc 848 Kathy Dianne Dr Indian Land SC 29707-6898 Ph: (443) 531-1988 | Conversion Therapeutic Services Inc 11535 Carmel Commons Blvd Ste 102 Charlotte NC 28226-5314 Ph: (704) 910-1788 |
| NPI Number | 1245094192 |
|---|---|
| Provider Enumeration Date | 02/12/2024 |
| Last Update Date | 10/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245094192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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