Organization
WIG OUT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE ROSS (OWNER)
(704) 231-8039
Entity
Organization
Contact information
Practice address
905 KENILWORTH AVE APT 413, CHARLOTTE, NC 28204-3523
(704) 457-0132
Mailing address
905 KENILWORTH AVE APT 413, CHARLOTTE, NC 28204-3523
(704) 457-0132
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/07/2025
Last updated
03/11/2026
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