MEDICARE: MECKLENBURG COUNTY AREA MENTAL HEALTH AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MHL-060-144	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003998212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MECKLENBURG COUNTY AREA MENTAL HEALTH AUTHORITY

Provider Business Mailing Address
First Line	:	429 BILLINGSLEY RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1007
Country	:	US
Telephone Number	:	704-336-2023
Fax Number	:	704-336-4383

Provider Business Practice Location Address
First Line	:	1210 N TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-3256
Country	:	US
Telephone Number	:	704-336-6615
Fax Number	:	704-423-2421

Authorized Official
Title or Position	:	AREA DIRECTOR
Name	:	GRAYCE CROCKETT
Credential	:
Telephone Number	:	704-336-8638

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/22/2020

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Directions to “MECKLENBURG COUNTY AREA MENTAL HEALTH AUTHORITY ” Practice Location

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