Healthcare Provider Details

I. General information

NPI: 1558033431
Provider Name (Legal Business Name): MARY CARTER PEERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 UNIVERSITY EXEC PARK DR STE 400
CHARLOTTE NC
28262-3356
US

IV. Provider business mailing address

8303 UNIVERSITY EXEC PARK DR STE 400
CHARLOTTE NC
28262-3356
US

V. Phone/Fax

Practice location:
  • Phone: 980-529-7206
  • Fax:
Mailing address:
  • Phone: 980-529-7206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4421
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: