Provider Demographics
NPI:1902487473
Name:CHARLOTTE LEADERSHIP FAMILY SERVICES
Entity Type:Organization
Organization Name:CHARLOTTE LEADERSHIP FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOAN
Authorized Official - Middle Name:DONETTE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-712-1195
Mailing Address - Street 1:2723 N GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-3531
Mailing Address - Country:US
Mailing Address - Phone:704-931-1196
Mailing Address - Fax:
Practice Address - Street 1:2723 N GRAHAM ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-3531
Practice Address - Country:US
Practice Address - Phone:704-931-1196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty