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General NPI Number Information
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NPI Number | 1114647013
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Entity Type | Individual
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Provider Name | CEDRIC DEAN CPP
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Gender | Male
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 2001 CATHERINE SIMMONS AVE
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City | CHARLOTTE
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State | NC
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Zip | 28216-4677
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Country | US
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Telephone | 704-492-1533
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Fax |
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Provider Business Mailing Address
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Address Line | 5502 MCCHESNEY DR
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City | CHARLOTTE
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State | NC
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Zip | 28269-7188
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Country | US
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Telephone | 704-492-5509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 2021877201
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 2021877201
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 2021877201
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 2021877201
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License Number State | NC
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