Healthcare Provider Details

I. General information

NPI: 1932949922
Provider Name (Legal Business Name): CMC VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E BROOKLYN VILLAGE AVE UNIT 338
CHARLOTTE NC
28202-3607
US

IV. Provider business mailing address

PO BOX 2071
INDIAN TRAIL NC
28079-2071
US

V. Phone/Fax

Practice location:
  • Phone: 980-206-4227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARNARRI COFIELD
Title or Position: CEO
Credential:
Phone: 980-206-4227