MEDICARE: ALLEN TERRELL HARGROVE

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	15472	NC

General Provider Information

NPI Number	:	1396385639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN TERRELL HARGROVE

Provider Business Mailing Address
First Line	:	4917 ALBEMARLE RD STE 106
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6454
Country	:	US
Telephone Number	:	704-567-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	4917 ALBEMARLE RD STE 106
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6454
Country	:	US
Telephone Number	:	704-567-3203
Fax Number	:	704-567-9522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/15/2020

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Directions to “ ALLEN TERRELL HARGROVE ” Practice Location

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