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General NPI Number Information
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NPI Number | 1639624034
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Entity Type | Organization
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Legal Business Name | CHOICES FOR RECOVERY, LLC
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 200 QUEENS RD STE 102
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City | CHARLOTTE
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State | NC
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Zip | 28204-3252
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Country | US
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Telephone | 980-237-6990
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Fax |
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Provider Business Mailing Address
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Address Line | 417 S SHARON AMITY RD STE C
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City | CHARLOTTE
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State | NC
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Zip | 28211-2883
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Country | US
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Telephone | 704-365-4170
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. HOLLIS H CRITTENDON
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Credential |
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Telephone | 704-439-7498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MHL-060-1317
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License Number State | NC
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