Balanced Space Wellness LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BALANCED SPACE WELLNESS LLC

Practice address

1125 Belmont Ave
Charlotte, NC 28205

Phone

(910) 710-6220

NPI assigned

May 8, 2025

Organization subpart

No

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

Authorized official

Name

Elaine Jackson, LCPCNPI 1700338142

Title

Owner

Phone

(704) 710-6220

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elaine Jackson, LCPC

  • Mental Health Counselor
  • Philadelphia, PA
  • NPI 1700338142
  NPD Authorized official

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

{
    "created_epoch": "1746662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773273600000",
    "number": "1801686209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 EAST BLVD STE E",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035876",
            "telephone_number": "704-710-6220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 BELMONT AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28205",
            "telephone_number": "910-710-6220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED SPACE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-08",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-710-6220",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2026; 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.