Healthcare Provider Details

I. General information

NPI: 1699045443
Provider Name (Legal Business Name): BEATTIES FORD ROAD FAMILY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 BEATTIES FORD RD
CHARLOTTE NC
28216-4550
US

IV. Provider business mailing address

1406 BEATTIES FORD RD
CHARLOTTE NC
28216-4550
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-9434
  • Fax: 704-332-9439
Mailing address:
  • Phone: 704-332-9434
  • Fax: 704-332-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: FRANCES HALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-332-9434