MEDICARE: PROFESSIONAL RESOURCES ENHANCING PERSONAL SUCCESS LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251B00000X	Case Management Agency
3	253Z00000X	In Home Supportive Care Agency
4	252Y00000X	Early Intervention Provider Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629538350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL RESOURCES ENHANCING PERSONAL SUCCESS LLP

Provider Business Mailing Address
First Line	:	1800 CAMDEN RD STE 107-137
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4690
Country	:	US
Telephone Number	:	704-712-1277
Fax Number	:

Provider Business Practice Location Address
First Line	:	4921 ALBEMARLE RD STE 108
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6654
Country	:	US
Telephone Number	:	980-819-6585
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. BELINDA A MCDONALD
Credential	:
Telephone Number	:	704-712-1277

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	11/17/2021

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