Healthcare Provider Details

I. General information

NPI: 1558984476
Provider Name (Legal Business Name): BEATTIES FORD ROAD VOCATIONAL TRADE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 DRY DOCK LOOP
MOORESVILLE NC
28117-8054
US

IV. Provider business mailing address

1406 BEATTIES FORD RD
CHARLOTTE NC
28216-4550
US

V. Phone/Fax

Practice location:
  • Phone: 980-349-4067
  • Fax: 980-209-9717
Mailing address:
  • Phone: 980-349-4067
  • Fax: 980-209-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. FRANCES REBECCA HALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 980-349-4067