Healthcare Provider Details

I. General information

NPI: 1518060318
Provider Name (Legal Business Name): ALEXANDER YOUTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 THERMAL RD
CHARLOTTE NC
28211-5630
US

IV. Provider business mailing address

6220 THERMAL RD
CHARLOTTE NC
28211-5630
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-8712
  • Fax: 704-362-8464
Mailing address:
  • Phone: 704-366-8712
  • Fax: 704-362-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL060968
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberLICENSE NOT NUMBERED
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BRENNON GRAHAM
Title or Position: CEO
Credential:
Phone: 704-366-8712