MEDICARE: ADVENE HEALTH GROUP, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	NC
2	101YM0800X	Mental Health Counselor	NC
3	1041C0700X	Clinical Social Worker
4	207QA0000X	Adolescent Medicine (Family Medicine) Physician	NC
5	207QA0401X	Addiction Medicine (Family Medicine) Physician	NC
6	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	NC
7	2084P0802X	Addiction Psychiatry Physician	NC
8	2084P0804X	Child & Adolescent Psychiatry Physician	NC
9	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	NC
10	261QM0850X	Adult Mental Health Clinic/Center	NC
11	261QR0400X	Rehabilitation Clinic/Center	NC
12	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	NC
13	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	NC
14	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	NC
15	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073931119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENE HEALTH GROUP, PLLC

Provider Business Mailing Address
First Line	:	1421 ORCHARD LAKE DRIVE
Second Line	:	SUITE C
City	:	CHARLOTTE
State	:	NC
Zip	:	28270
Country	:	US
Telephone Number	:	704-844-0181
Fax Number	:	904-701-6279

Provider Business Practice Location Address
First Line	:	1421 ORCHARD LAKE DRIVE
Second Line	:	SUITE C
City	:	CHARLOTTE
State	:	NC
Zip	:	28270
Country	:	US
Telephone Number	:	704-844-0181
Fax Number	:	904-701-6279

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LAURA A SEITZ
Credential	:	LCSW
Telephone Number	:	704-844-0181

Provider Enumeration Date	:	04/05/2014
Last Update Date	:	03/31/2015

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