The Counselor Wellness Center, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

THE COUNSELOR WELLNESS CENTER, PLLC

Practice address

2108 South Blvd Ste 211-1058
Charlotte, NC 28203-5043

Phone

(704) 208-4667

Fax

(704) 200-2686

NPI assigned

Dec 21, 2023

Organization subpart

No

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

Authorized official

Name

Dazzmen Nikole Davis, LCMHC

Title

Lcmhc /Practice Owner

Phone

(470) 709-3822

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1703116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703116800000",
    "number": "1740059591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 SOUTH BLVD STE 211-1058",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035043",
            "telephone_number": "704-208-4667",
            "fax_number": "704-200-2686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 SOUTH BLVD STE 211-1058",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035043",
            "telephone_number": "704-208-4667",
            "fax_number": "704-200-2686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COUNSELOR WELLNESS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-21",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "DAZZMEN",
        "authorized_official_middle_name": "NIKOLE",
        "authorized_official_title_or_position": "LCMHC /PRACTICE OWNER",
        "authorized_official_telephone_number": "470-709-3822",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; 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.