Organization
PROVISIONS COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHIRICKA LASHAYE FAIR PHD, LMFT (EXECUTIVE DIRECTOR)
(704) 750-0655
Entity
Organization
Contact information
Practice address
1000 BAXTER ST, CHARLOTTE, NC 28204-2859
(704) 750-0655
Mailing address
5115 MINTVALE DR, CHARLOTTE, NC 28269-1689
(704) 750-0655
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1484
NC
106H00000X
Marriage & Family Therapist
1484
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326339185
—
NC
Enumeration date
10/10/2017
Last updated
12/06/2017
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