Organization
INNOVATIVE LIFESTYLE NETWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANIKA JOHNSON M.S, LPC (OWNER/THERAPIST)
(704) 421-1330
Entity
Organization
Contact information
Practice address
301 MCCULLOUGH DR STE 400, CHARLOTTE, NC 28262-1336
(704) 504-7274
(704) 919-5564
Mailing address
301 MCCULLOUGH DR STE 400, CHARLOTTE, NC 28262-1336
(704) 504-7274
(704) 919-5564
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/11/2019
Last updated
07/28/2022
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