Healthcare Provider Details

I. General information

NPI: 1144349630
Provider Name (Legal Business Name): CATHOLIC CHARITIES DIOCESE OF CHARLOTEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 S CHURCH ST
CHARLOTTE NC
28203-4003
US

IV. Provider business mailing address

1123 S CHURCH ST
CHARLOTTE NC
28203-4003
US

V. Phone/Fax

Practice location:
  • Phone: 704-370-3262
  • Fax: 704-370-3377
Mailing address:
  • Phone: 704-370-3262
  • Fax: 704-370-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name: AMY H LOESCH
Title or Position: BUSINESS OPERATIONS
Credential:
Phone: 704-370-3233