Gbaum

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

5431 Issued in NC

Legal business name

GBAUM

Practice address

5111 Nations Crossing Rd
Building 8 Suite 226
Charlotte, NC 28217-2126

Phone

(803) 984-0124

Fax

(704) 504-5021

NPI assigned

Jun 22, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jamila Safiya Nettles-Felder, LPC

Title

Owner

Phone

(803) 984-0124

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245628800000",
    "number": "1154558724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5111 NATIONS CROSSING RD",
            "address_2": "BUILDING 8 SUITE 226",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282172126",
            "telephone_number": "803-984-0124",
            "fax_number": "704-504-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5111 NATIONS CROSSING RD",
            "address_2": "BUILDING 8 SUITE 226",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282172126",
            "telephone_number": "803-984-0124",
            "fax_number": "704-504-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GBAUM",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-22",
        "last_updated": "2009-06-22",
        "status": "A",
        "authorized_official_last_name": "NETTLES-FELDER",
        "authorized_official_first_name": "JAMILA",
        "authorized_official_middle_name": "SAFIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-984-0124",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "5431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103628",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.