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Organization
KINTSUGI COUNSELING PROFESSIONAL LIMITED LIABILITY COMPANY
Active
Organization
KINTSUGI COUNSELING PROFESSIONAL LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NAOMI DE LA CRUZ SPENCER (OWNER THERAPIST)
(704) 644-9613
Entity
Organization
Contact information
Practice address
322 LAMAR AVE STE 209, CHARLOTTE, NC 28204-2436
(704) 644-9613
Mailing address
1403 EASTCREST DR APT 202, CHARLOTTE, NC 28205-8277
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689191983
NPI FOR PRIVATE INSURANCE
—
01
—
1962854505
NPI FOR PRIVATE INSURANCE
—
Enumeration date
10/07/2019
Last updated
10/07/2019
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