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General NPI Number Information
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NPI Number | 1255692919
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Entity Type | Organization
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Legal Business Name | TRAUMA ASSESSMENT & TREATMENT CENTER, PLLC
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 1914 J N PEASE PL STE 150
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City | CHARLOTTE
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State | NC
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Zip | 28262-4504
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Country | US
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Telephone | 704-921-9943
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Fax | 704-665-1959
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Provider Business Mailing Address
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Address Line | 8531 RIDGELINE LN
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City | CHARLOTTE
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State | NC
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Zip | 28269-8000
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Country | US
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Telephone | 704-921-9943
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Fax | 704-665-1959
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Authorized Official
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Title or Position | LCSW, CCTP/ CLINICAL DIRECTOR
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Name | LESLIE WILLIAMS
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Credential | LCSW, CCTP
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Telephone | 704-921-9943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006756
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License Number State | NC
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