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General NPI Number Information
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NPI Number | 1891976015
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Entity Type | Organization
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Legal Business Name | MECKLENBURG COUNTY AREA MH, DD AND SA AUTHORITY
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 720 E 4TH ST
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City | CHARLOTTE
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State | NC
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Zip | 28202-2884
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Country | US
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Telephone | 704-432-1020
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Fax | 704-432-1021
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Provider Business Mailing Address
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Address Line | 429 BILLINGSLEY RD
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City | CHARLOTTE
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State | NC
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Zip | 28211-1007
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Country | US
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Telephone | 704-336-2023
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Fax | 704-336-8591
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Authorized Official
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Title or Position | AREA DIRECTOR
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Name | MRS. GRAYCE CROCKETT
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Credential | LCSW
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Telephone | 704-336-8638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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