Healthcare Provider Details

I. General information

NPI: 1891165684
Provider Name (Legal Business Name): INREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CLANTON RD STE A
CHARLOTTE NC
28217-1391
US

IV. Provider business mailing address

4014 MONROE RD STE 170
CHARLOTTE NC
28205-0094
US

V. Phone/Fax

Practice location:
  • Phone: 704-536-6661
  • Fax:
Mailing address:
  • Phone: 704-536-6661
  • Fax: 704-536-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberMHL-060-1204
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LORI A GOUGEON
Title or Position: PRESIDENT
Credential: BS
Phone: 704-536-6661