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General NPI Number Information
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NPI Number | 1811237365
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Entity Type | Organization
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Legal Business Name | A HERITAGE CHILD NETWORK, INC
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 808 CIRCLE DR
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City | MONROE
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State | NC
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Zip | 28112-3800
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Country | US
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Telephone | 704-619-3490
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Fax | 704-849-5251
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Provider Business Mailing Address
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Address Line | 7633 PINEVILLE MATTHEWS RD BOX 10
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City | CHARLOTTE
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State | NC
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Zip | 28226-3909
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Country | US
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Telephone | 704-619-3490
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Fax | 704-849-5251
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Authorized Official
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Title or Position | CEO
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Name | MS. GLENDA LENA VINSON-NNAJI
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Credential | LPC
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Telephone | 704-619-3490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 101YP2500X
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License Number State | NC
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