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General NPI Number Information
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NPI Number | 1104303635
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Entity Type | Organization
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Legal Business Name | GREENBROOK TMS CHARLOTTE LLC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 1515 MOCKINGBIRD LN STE 340
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City | CHARLOTTE
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State | NC
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Zip | 28209-3298
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Country | US
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Telephone | 855-910-4867
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Fax |
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Provider Business Mailing Address
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Address Line | 8405 GREENSBORO DR STE 120
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City | MC LEAN
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State | VA
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Zip | 22102-5106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | NICOLE LOWRY
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Credential |
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Telephone | 855-910-4867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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