Provider Demographics
NPI:1720828932
Name:MENTAL WELLTH COUNSELING SOLUTIONS
Entity type:Organization
Organization Name:MENTAL WELLTH COUNSELING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANTRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:980-477-5005
Mailing Address - Street 1:1610 HUDSON GRAHAM LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1009
Mailing Address - Country:US
Mailing Address - Phone:980-477-5005
Mailing Address - Fax:
Practice Address - Street 1:1235 EAST BLVD STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5876
Practice Address - Country:US
Practice Address - Phone:980-477-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty