NPIMap

Organization Active NPI

Transformative Life Center, LLC.

  • Clinical Psychologist
  • Charlotte, NC
National Provider Identifier
1316256555
Registry record updated Oct 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3909 Issued in NC
Legal business name
TRANSFORMATIVE LIFE CENTER, LLC.
Practice address
3440 Toringdon Way
Suite 205
Charlotte, NC 28277-3190
Phone
(877) 747-5520
Fax
(877) 539-5520
NPI assigned
Oct 6, 2010
Organization subpart
Yes
Parent organization
TRANSFORMATIVE LIFE CENTER, LLC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 6, 2010

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

Authorized official

Name
Mr. Lewis Evans
Title
Owner
Phone
(877) 747-5520

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 3909 NC Primary

Addresses

Primary practice location

3440 Toringdon Way
Suite 205
Charlotte, NC 28277-3190

Mailing address

3440 Toringdon Way
Suite 205
Charlotte, NC 28277-3190
Phone (877) 747-5520

Other names 1

  • Senior Health Source Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Transformative Life Center4 organizations share this tax ID, including this one
Part of
Transformative Life Center

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286323200000",
    "number": "1316256555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 TORINGDON WAY",
            "address_2": "SUITE 205",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282773190",
            "telephone_number": "877-747-5520",
            "fax_number": "877-539-5520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 TORINGDON WAY",
            "address_2": "SUITE 205",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282773190",
            "telephone_number": "877-747-5520",
            "fax_number": "877-539-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSFORMATIVE LIFE CENTER, LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRANSFORMATIVE LIFE CENTER, LLC.",
        "enumeration_date": "2010-10-06",
        "last_updated": "2010-10-06",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "877-747-5520",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "3909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior Health Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2010; 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.