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NPI Code Detail

MEDICARE: SOUTHSIDE COUNSELING CENTER, LLC

MEDICARE: SOUTHSIDE COUNSELING CENTER, LLC
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
1251S00000XCommunity/Behavioral Health Agency8778NC

Other Identifiers

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

General Provider Information

NPI Number : 1356604235
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHSIDE COUNSELING CENTER, LLC
Provider Business Mailing Address
First Line : 2015 AYRSLEY TOWN BLVD STE 202
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-4068
Country : US
Telephone Number : 704-280-8531
Fax Number :
Provider Business Practice Location Address
First Line : 2015 AYRSLEY TOWN BLVD STE 202
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-4068
Country : US
Telephone Number : 704-280-8531
Fax Number :
Authorized Official
Title or Position : OWNER/MEMBER
Name : ERIN E RICE
Credential : LPC
Telephone Number : 828-545-0601
Provider Enumeration Date : 06/17/2012
Last Update Date : 06/17/2012

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Directions to “SOUTHSIDE COUNSELING CENTER, LLC ” Practice Location

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