MEDICARE: MS. ACCOUNTABILITY TRANSFORMATIONAL GROUP

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	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1669148706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MS. ACCOUNTABILITY TRANSFORMATIONAL GROUP

Provider Business Mailing Address
First Line	:	12436 BENDING BRANCH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-3659
Country	:	US
Telephone Number	:	704-345-0613
Fax Number	:

Provider Business Practice Location Address
First Line	:	12436 BENDING BRANCH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-3659
Country	:	US
Telephone Number	:	704-345-0613
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. TERRITA LACHE CHAMBERS
Credential	:	LCMHC
Telephone Number	:	704-345-0613

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	08/18/2021

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