Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Willow Residential LLC

Organization Emotionally Disturbed Childrens' Residential Treatment Facility · NPI 1154252203

Willow Residential LLC is an Emotionally Disturbed Childrens' Residential Treatment Facility in Charlotte, North Carolina. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

2631 Kenhill Dr
Charlotte, NC 28208-5912
Phone: (704) 749-4564
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emotionally Disturbed Childrens' Residential Treatment Facility (primary) Taxonomy 322D00000X

Record details

NPI number1154252203
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Amantii Samson — Owner · (704) 749-4564
NPI enumeratedMay 27, 2026
Last updated in NPPESMay 27, 2026
Certification dateMay 27, 2026
Mailing address2631 Kenhill Dr, Charlotte, NC 28208-5912

Other providers in Charlotte