Individual
FOX MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
LMBT
Contact information
Practice address
3508 THE PLAZA, CHARLOTTE, NC 28205
(828) 407-7708
Mailing address
3508 THE PLAZA, CHARLOTTE, NC 28205
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21249
NC
Other
Enumeration date
03/04/2025
Last updated
03/04/2025
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