MEDICARE: MOTIVATION & INSPIRATION FAMILY SERVICES

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1487952362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTIVATION & INSPIRATION FAMILY SERVICES

Provider Business Mailing Address
First Line	:	7008 E WT HARRIS BLVD STE 7
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4298
Country	:	US
Telephone Number	:	704-566-3730
Fax Number	:

Provider Business Practice Location Address
First Line	:	7008 E WT HARRIS BLVD STE 7
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4298
Country	:	US
Telephone Number	:	704-566-3730
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DERRICK RALEY
Credential	:
Telephone Number	:	704-566-3730

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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