Healthcare Provider Details

I. General information

NPI: 1104015023
Provider Name (Legal Business Name): BEHAVIORAL HEALTH CENTER CMC RANDOLPH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEHAVIORAL HEALTH CENTER CMC RANDOLPH 501 BILLINGSLEY ROAD
CHARLOTTE NC
28211-1009
US

IV. Provider business mailing address

BEHAVIORAL HEALTH CENTER CMC RANDOLPH 501 BILLINGSLEY ROAD
CHARLOTTE NC
28211-1009
US

V. Phone/Fax

Practice location:
  • Phone: 704-444-2539
  • Fax: 704-444-2539
Mailing address:
  • Phone: 704-358-2710
  • Fax: 704-358-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberH0071
License Number StateNC

VIII. Authorized Official

Name: THOMAS E. GETTELMAN
Title or Position: ASSISTANT VICE PRESIDENT
Credential: PHD
Phone: 704-444-2406