MEDICARE: MLC HOLDINGS LLC

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1508711441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MLC HOLDINGS LLC

Provider Business Mailing Address
First Line	:	5511 MONROE RD STE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-5503
Country	:	US
Telephone Number	:	980-622-2177
Fax Number	:	980-366-6848

Provider Business Practice Location Address
First Line	:	5511 MONROE RD STE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-5503
Country	:	US
Telephone Number	:	980-622-2177
Fax Number	:	980-366-6848

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER LASTER
Credential	:	NCPSSS
Telephone Number	:	980-622-2177

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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1467663013 — MR. WESLEY JAY MOONE L.P.A.
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Directions to “MLC HOLDINGS LLC ” Practice Location

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