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NPI Code Detail

MEDICARE: PROJECT 658

MEDICARE: PROJECT 658
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
1106H00000XMarriage & Family Therapist10040ANC
2163W00000XRegistered Nurse238539NC

General Provider Information

NPI Number : 1427502558
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROJECT 658
Provider Business Mailing Address
First Line : 3646 CENTRAL AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-6064
Country : US
Telephone Number : 704-733-9934
Fax Number : 704-733-9925
Provider Business Practice Location Address
First Line : 3622 CENTRAL AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-5638
Country : US
Telephone Number : 704-910-5810
Fax Number : 980-207-0214
Authorized Official
Title or Position : CLINIC COORDINATOR
Name : MRS. MARJORIE LUGIBIHL
Credential : RN
Telephone Number : 704-733-9934
Provider Enumeration Date : 08/05/2016
Last Update Date : 07/21/2022

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Directions to “PROJECT 658 ” Practice Location

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