Provider Demographics
NPI:1548890908
Name:MENDED COUNSELING & CONSULTATION
Entity type:Organization
Organization Name:MENDED COUNSELING & CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:313-212-4194
Mailing Address - Street 1:5009 BEATTIES FORD RD STE 107-251
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2859
Mailing Address - Country:US
Mailing Address - Phone:704-352-9391
Mailing Address - Fax:704-210-5173
Practice Address - Street 1:615 E 6TH ST STE 114
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2918
Practice Address - Country:US
Practice Address - Phone:704-352-9391
Practice Address - Fax:704-270-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty