MEDICARE: NORTH CAROLINA INTEGRATED SERVICES 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1669335873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CAROLINA INTEGRATED SERVICES LLC

Provider Business Mailing Address
First Line	:	9805 STATESVILLE RD # 4006
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7647
Country	:	US
Telephone Number	:	980-270-6447
Fax Number	:

Provider Business Practice Location Address
First Line	:	9805 STATESVILLE RD # 4006
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7647
Country	:	US
Telephone Number	:	980-270-6447
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ISAAC WIEDER
Credential	:
Telephone Number	:	980-270-6447

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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