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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. ANNIE FONGHEISER MA, MS, MAC, LCAS (OWNER)
(704) 813-4555
Entity
Organization

Contact information

Practice address
409 ARROWOOD AVE, LANCASTER, SC 29720-1503
(704) 813-4555
Mailing address
3140 HWY 16 N., SUITE 103, DENVER, NC 28036-7314
(704) 813-4555
(704) 296-5500

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
945
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6112011
NC
Enumeration date
11/03/2008
Last updated
11/03/2008
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