Healthcare Provider Details

I. General information

NPI: 1972166635
Provider Name (Legal Business Name): BEATTIES FORD ROAD VOCATIONAL TRADE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
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: 980-349-4067
  • Fax: 980-209-9717
Mailing address:
  • Phone: 980-349-4067
  • Fax: 980-209-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
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
# 5
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. FRANCES REBECCA HALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 980-349-4067