=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407163462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW PLACE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2010
-----------------------------------------------------
Last Update Date | 09/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6612 E HARRIS BLVD STE D
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28215-5135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-567-8984
-----------------------------------------------------
Fax | 704-567-8954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6612 E HARRIS BLVD STE D
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28215-5135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-567-8984
-----------------------------------------------------
Fax | 704-567-8954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. JAMES HUNT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-567-8984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 8075
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 8075
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 8075
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------