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General NPI Number Information
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NPI Number | 1205388014
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Entity Type | Organization
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Legal Business Name | WILLIAM FAMILY DEVELOPMENT LLC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 11430 COREOPSIS RD
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City | CHARLOTTE
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State | NC
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Zip | 28213-9261
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Country | US
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Telephone | 704-905-5688
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 49132
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City | CHARLOTTE
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State | NC
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Zip | 28277-0074
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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 | COMPLIANCE ADMINISTRATOR
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Name | FRANCINA BREWER
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Credential |
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Telephone | 704-905-5688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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