# JADE INTEGRATIVE COUNSELING AND WELLNESS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245879022
- **Authorized official:** MRS. CHARRYSE A JOHNSON MA, LPC (OWNER)
- **Authorized official phone:** (980) 701-4192

## Contact information

- **Practice address:** 5970 FAIRVIEW RD STE 420, CHARLOTTE, NC 28210-3167
- **Practice address phone:** (980) 701-4192
- **Practice address fax:** (980) 701-4194
- **Mailing address:** 5970 FAIRVIEW RD STE 420, CHARLOTTE, NC 28210-3167
- **Mailing address phone:** (980) 701-4192
- **Mailing address fax:** (980) 701-4194

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 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