Healthcare Provider Details

I. General information

NPI: 1871747048
Provider Name (Legal Business Name): S&L SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 TUCKASEEGEE RD
CHARLOTTE NC
28208-2832
US

IV. Provider business mailing address

4000 TUCKASEEGEE RD
CHARLOTTE NC
28208-2832
US

V. Phone/Fax

Practice location:
  • Phone: 704-399-2558
  • Fax: 704-399-2559
Mailing address:
  • Phone: 704-399-2558
  • Fax: 704-399-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SCHANDRA NICHOLE HALEY
Title or Position: CEO
Credential:
Phone: 704-399-2558