Provider Demographics
NPI:1801075510
Name:ERVIN HOUSE
Entity type:Organization
Organization Name:ERVIN HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-426-9457
Mailing Address - Street 1:2022 SYRACUSE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-4421
Mailing Address - Country:US
Mailing Address - Phone:704-426-9457
Mailing Address - Fax:
Practice Address - Street 1:1069 BRIANNA WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1261
Practice Address - Country:US
Practice Address - Phone:704-426-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-1010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty