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General NPI Number Information
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NPI Number | 1316291552
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Entity Type | Organization
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Legal Business Name | COLLEGIATE GLOBAL NETWORK
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 816 DRUMMOND AVE
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City | CHARLOTTE
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State | NC
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Zip | 28205
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Country | US
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Telephone | 704-241-1135
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 791154
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City | CHARLOTTE
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State | NC
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Zip | 28206-7918
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Country | US
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Telephone | 704-241-1135
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER L DAVIS
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Credential |
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Telephone | 704-241-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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