MEDICARE: QUANTUM CENTER FOR HUMAN CHANGE, 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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1699611665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUANTUM CENTER FOR HUMAN CHANGE, LLC

Provider Business Mailing Address
First Line	:	740 W 5TH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-1408
Country	:	US
Telephone Number	:	704-779-4629
Fax Number	:

Provider Business Practice Location Address
First Line	:	7260 HIGHLAND CREEK PKWY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0805
Country	:	US
Telephone Number	:	704-779-4629
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. THADIUS LEONARD BONAPART III
Credential	:	QMHP/QDDP
Telephone Number	:	704-779-4629

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	06/04/2026

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