Healthcare Provider Details

I. General information

NPI: 1427713577
Provider Name (Legal Business Name): WELLPATH COMMUNITY CARE CENTERS OF NORTH CAROLINA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 W SUGAR CREEK RD
CHARLOTTE NC
28262-3168
US

IV. Provider business mailing address

1283 MURFREESBORO PIKE STE 500
NASHVILLE TN
37217-2421
US

V. Phone/Fax

Practice location:
  • Phone: 980-346-5678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN DESCOTEAUX
Title or Position: PC OWNER
Credential: MD
Phone: 615-838-9333