MEDICARE: BUILDING ENDURANCE

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	251S00000X	Community/Behavioral Health Agency	C010048	NC

General Provider Information

NPI Number	:	1184179087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING ENDURANCE

Provider Business Mailing Address
First Line	:	1935 J N PEASE PL STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 J N PEASE PL STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4541
Country	:	US
Telephone Number	:	980-288-5486
Fax Number	:

Authorized Official
Title or Position	:	ORGANIZER
Name	:	ALICIA TETTEH
Credential	:	LCSW
Telephone Number	:	202-294-1248

Provider Enumeration Date	:	08/20/2016
Last Update Date	:	11/24/2020

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Directions to “BUILDING ENDURANCE ” Practice Location

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