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Organization
JADE INTEGRATIVE COUNSELING AND WELLNESS, PLLC
Active
Organization
JADE INTEGRATIVE COUNSELING AND WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARRYSE A JOHNSON MA, LPC (OWNER)
(980) 701-4192
Entity
Organization
Contact information
Practice address
5970 FAIRVIEW RD STE 420, CHARLOTTE, NC 28210-3167
(980) 701-4192
(980) 701-4194
Mailing address
5970 FAIRVIEW RD STE 420, CHARLOTTE, NC 28210-3167
(980) 701-4192
(980) 701-4194
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
NULL
103TB0200X
Cognitive & Behavioral Psychologist
—
—
Other
Enumeration date
12/27/2019
Last updated
12/27/2019
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