Healthcare Provider Details

I. General information

NPI: 1700281375
Provider Name (Legal Business Name): INDIVIDUALIZED TREATMENT SOLUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 MAIN ST STE 10
SHALLOTTE NC
28470-4581
US

IV. Provider business mailing address

1747 GRISSETT RD SW
SUPPLY NC
28462-3070
US

V. Phone/Fax

Practice location:
  • Phone: 910-393-9409
  • Fax: 910-842-9927
Mailing address:
  • Phone: 910-393-9409
  • Fax: 910-842-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON A. WOODARD CRAWFORD
Title or Position: OWNER
Credential:
Phone: 910-393-9409