MEDICARE: FUND-A-MENTAL IN EDUCATION TRAINING & CONSULTING

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

General Provider Information

NPI Number	:	1053716878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUND-A-MENTAL IN EDUCATION TRAINING & CONSULTING

Provider Business Mailing Address
First Line	:	6612 E W T HARRIS BLVD
Second Line	:	SUITE D
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5134
Country	:	US
Telephone Number	:	704-567-8984
Fax Number	:	704-567-8953

Provider Business Practice Location Address
First Line	:	6612 E W T HARRIS BLVD
Second Line	:	SUITE D
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5134
Country	:	US
Telephone Number	:	704-567-8984
Fax Number	:	704-567-8953

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. HAWA ELIZABETH HUNT
Credential	:	MBA
Telephone Number	:	704-567-8953

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	10/23/2014

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