Healthcare Provider Details

I. General information

NPI: 1477683308
Provider Name (Legal Business Name): AUTISM SERVICES OF MECKLENBURG COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211-A EXECUTIVE STREET
CHARLOTTE NC
28208-3655
US

IV. Provider business mailing address

2211-A EXECUTIVE STREET
CHARLOTTE NC
28208-3655
US

V. Phone/Fax

Practice location:
  • Phone: 704-392-9220
  • Fax: 704-392-9221
Mailing address:
  • Phone: 704-392-9220
  • Fax: 704-392-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License NumberMHL-060-231
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License NumberMHL-060-167
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License NumberMHL-060-118
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License NumberMHL-060-514
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-060-350
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-060-908
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-060-468
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-060-166
License Number StateNC
# 10
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MARCY ALFORD
Title or Position: BUSINESS MANAGER
Credential:
Phone: 704-392-9220