Individual
EPIC STORM-WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6801 NORTHLAKE MALL DR STE 103, CHARLOTTE, NC 28216-0713
(919) 238-7380
Mailing address
6801 NORTHLAKE MALL DR STE 103, CHARLOTTE, NC 28216-0713
(919) 903-0402
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CADC-30173
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NC
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
175T00000X
Peer Specialist
—
NC
374J00000X
Doula
7081-19
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7081-19
MADRIELLA DOULA CERTIFICATION
CA
Enumeration date
09/15/2022
Last updated
04/11/2025
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