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General NPI Number Information
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NPI Number | 1801500624
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Entity Type | Organization
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Legal Business Name | MIKE D MANAGEMENT
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 170 MEDICAL PARK RD STE 207
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City | MOORESVILLE
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State | NC
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Zip | 28117-8583
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Country | US
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Telephone | 704-604-9272
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Fax |
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Provider Business Mailing Address
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Address Line | 2399 CAPITAL CLUB WAY APT 200
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City | INDIAN LAND
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State | SC
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Zip | 29707-6141
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Country | US
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Telephone | 704-604-9272
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL ANDRE DOLAN
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Credential |
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Telephone | 704-604-9272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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