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General NPI Number Information
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NPI Number | 1104250919
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Entity Type | Organization
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Legal Business Name | MEDTRAC SOLUTIONS
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 537 W SUGAR CREEK RD STE 102
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City | CHARLOTTE
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State | NC
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Zip | 28213-6102
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Country | US
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Telephone | 704-819-6212
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Fax | 704-469-4714
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Provider Business Mailing Address
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Address Line | 537 W SUGAR CREEK RD STE 102
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City | CHARLOTTE
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State | NC
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Zip | 28213-6102
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Country | US
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Telephone | 704-819-6212
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Fax | 704-469-4714
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. GARY L SMITH
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Credential |
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Telephone | 704-819-6212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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