Individual
DR. LISA PETTY-HARTGROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DBA
Contact information
Practice address
1010 GROVES ST STE 2, KINGS MOUNTAIN, NC 28086-2230
(980) 404-1809
(980) 352-0704
Mailing address
PO BOX 671, GASTONIA, NC 28053-0671
(980) 404-1809
(980) 352-0704
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
172V00000X
Community Health Worker
Primary
—
—
174H00000X
Health Educator
—
—
Other
Enumeration date
12/22/2020
Last updated
12/22/2020
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