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General NPI Number Information
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NPI Number | 1437491248
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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 | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 1801 N TRYON ST STE 325
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City | CHARLOTTE
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State | NC
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Zip | 28206-2704
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Country | US
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Telephone | 704-891-6404
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Fax | 980-225-0560
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Provider Business Mailing Address
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Address Line | 1801 N TRYON ST STE 325
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City | CHARLOTTE
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State | NC
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Zip | 28206-2704
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Country | US
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Telephone | 704-891-6404
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Fax | 980-225-0560
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/OWNER
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Name | AMEER GREEN
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Credential | BSW, QDDP, QMHP
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C005677
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License Number State | NC
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