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NPI Code Detail

MEDICARE: CHAREE BOULTER PHD

MEDICARE: CHAREE BOULTER PHD
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
1103TA0400XAddiction (Substance Use Disorder) Psychologist3380NC

General Provider Information

NPI Number : 1700083383
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHAREE BOULTER PHD
Provider Business Mailing Address
First Line : 6633 FAIRVIEW RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3321
Country : US
Telephone Number : 215-482-8000
Fax Number :
Provider Business Practice Location Address
First Line : 6633 FAIRVIEW RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3321
Country : US
Telephone Number : 215-482-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 07/08/2007

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