Healthcare Provider Details

I. General information

NPI: 1659745909
Provider Name (Legal Business Name): CHOICES FOR RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 QUEENS ROAD SUITE 102
CHARLOTTE NC
28204
US

IV. Provider business mailing address

417C S. SHARON AMITY RD
CHARLOTTE NC
28211
US

V. Phone/Fax

Practice location:
  • Phone: 704-969-4182
  • Fax: 704-365-4171
Mailing address:
  • Phone: 704-969-4182
  • Fax: 704-365-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. WILLIAM BURRELL CRITTENDON JR.
Title or Position: MANAGER
Credential:
Phone: 704-969-4182