Healthcare Provider Details

I. General information

NPI: 1164022570
Provider Name (Legal Business Name): DIRECTIONAL CARE COMMUNITY SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 SID CRANE DR
CHARLOTTE NC
28216-7684
US

IV. Provider business mailing address

6220 SID CRANE DR
CHARLOTTE NC
28216-7684
US

V. Phone/Fax

Practice location:
  • Phone: 704-491-9482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KYLA JEFFERSON
Title or Position: OWNER
Credential:
Phone: 704-491-9482