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General NPI Number Information
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NPI Number | 1144456104
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE RECOVERY RESOURCES LLC
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 3129 CREIGHTON DR
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City | CHARLOTTE
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State | NC
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Zip | 28205-6209
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Country | US
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Telephone | 704-891-6404
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Fax |
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Provider Business Mailing Address
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Address Line | 3129 CREIGHTON DR
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City | CHARLOTTE
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State | NC
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Zip | 28205-6209
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Country | US
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Telephone | 704-891-6404
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. AMEER GREEN
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Credential | BSW, QMHP,QDDP
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Telephone | 704-891-6404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NC
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