MEDICARE: MR. PHILIP MICHAEL FALCO LCMHC

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	101YM0800X	Mental Health Counselor	A16338	NC

General Provider Information

NPI Number	:	1336731751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP MICHAEL FALCO LCMHC

Provider Business Mailing Address
First Line	:	5901 AVELON VALLEY DR APT 937
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4580
Country	:	US
Telephone Number	:	425-590-7783
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 CARMEL EXECUTIVE PARK DR STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1307
Country	:	US
Telephone Number	:	704-398-3928
Fax Number	:	704-398-3928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	02/08/2021

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