MEDICARE: ANOTHER LEVEL COUNSELING AND CONSULTATION

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	2084P0800X	Psychiatry Physician	200600848	NC

General Provider Information

NPI Number	:	1336468347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOTHER LEVEL COUNSELING AND CONSULTATION

Provider Business Mailing Address
First Line	:	1927 JN PEASE PL STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1927 JN PEASE PL STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4536
Country	:	US
Telephone Number	:	704-548-5298
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SONYIA RICHARDSON
Credential	:
Telephone Number	:	704-548-5298

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	06/01/2010

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