MEDICARE: THOUSAND BRANCHES PROFESSIONALS EAST COAST PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1043164361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOUSAND BRANCHES PROFESSIONALS EAST COAST PLLC

Provider Business Mailing Address
First Line	:	4530 PARK RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3790
Country	:	US
Telephone Number	:	980-360-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 PARK RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3790
Country	:	US
Telephone Number	:	980-360-6100
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	STEVE FILTON
Credential	:
Telephone Number	:	610-768-3300

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/26/2026

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