MEDICARE: D & K ON CALL THERAPEUTIC EDUCATIONAL RESOURCE SERVICES, INC.

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
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1386704443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D & K ON CALL THERAPEUTIC EDUCATIONAL RESOURCE SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 31324
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28231-1324
Country	:	US
Telephone Number	:	704-814-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 ORCHARD LAKE DR
Second Line	:	SUITE B
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1474
Country	:	US
Telephone Number	:	704-814-0330
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARILYN MACK HUTCHINS
Credential	:
Telephone Number	:	704-814-0330

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	06/30/2010

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