Organization
INDIVIDUAL, COUPLE, AND FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES LEONARD RIVENBARK LCAS, LPC, LMFT, MAC (DIRECTOR)
(980) 254-5401
Entity
Organization
Contact information
Practice address
1850 E 3RD ST, SUITE 125, CHARLOTTE, NC 28204-3238
(980) 254-5401
Mailing address
1850 E 3RD ST, SUITE 125, CHARLOTTE, NC 28204-3238
(980) 254-5401
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LCAS 1243
NC
251S00000X
Community/Behavioral Health Agency
LMFT 965
NC
251S00000X
Community/Behavioral Health Agency
LPC 5490
NC
Other
Enumeration date
09/16/2008
Last updated
09/16/2008
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