MEDICARE: THE 11TH HOUR GLOBAL MISSION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC1900X	Counseling Psychologist
2	103TH0100X	Health Service Psychologist
3	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1043942451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE 11TH HOUR GLOBAL MISSION

Provider Business Mailing Address
First Line	:	17165 RED FEATHER DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2991
Country	:	US
Telephone Number	:	704-307-3035
Fax Number	:

Provider Business Practice Location Address
First Line	:	17165 RED FEATHER DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2991
Country	:	US
Telephone Number	:	704-307-3035
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEVEN GLENNON YEBOAH
Credential	:
Telephone Number	:	704-307-3035

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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Directions to “THE 11TH HOUR GLOBAL MISSION ” Practice Location

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