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NPI Code Detail

MEDICARE: HEAD INJURY CENTER OF CHARLOTTE, INC.

MEDICARE: HEAD INJURY CENTER OF CHARLOTTE, INC.
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
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1780684522
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEAD INJURY CENTER OF CHARLOTTE, INC.
Provider Business Mailing Address
First Line : 6853 FAIRVIEW RD
Second Line : STE B
City : CHARLOTTE
State : NC
Zip : 28210-3363
Country : US
Telephone Number : 704-366-9930
Fax Number : 704-366-9931
Provider Business Practice Location Address
First Line : 6853 FAIRVIEW RD
Second Line : SUITE B
City : CHARLOTTE
State : NC
Zip : 28210-3363
Country : US
Telephone Number : 704-366-9930
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. PETER JEFFREY EWERT
Credential : PH. D.
Telephone Number : 704-366-9930
Provider Enumeration Date : 07/22/2005
Last Update Date : 09/25/2009

Similar Medicare Providers

1730188020 — MR. PETER JEFFREY EWERT PHD
Practice Location Address:
6853 FAIRVIEW RD , STE B
CHARLOTTE, NC
28210-3363
Practice Phone: 704-366-9930
Practice Fax: 704-366-9931
1962474205 — MS. CAROL A. KOLB MA, LMFT, LPC
Practice Location Address:
6845 FAIRVIEW RD
CHARLOTTE, NC
28210-3363
Practice Phone: 704-364-4333
Practice Fax: 704-969-1175
1437108651 — MRS. LINDA M SMITH MA, LPC, NCC
Practice Location Address:
6845 FAIRVIEW RD
CHARLOTTE, NC
28210-3363
Practice Phone: 704-364-4333
Practice Fax: 704-969-1175
1275697286 — DR. ANGELA KAY LOUIE M.D.
Practice Location Address:
6845 FAIRVIEW RD
CHARLOTTE, NC
28210-3363
Practice Phone: 980-819-1807
Practice Fax: 919-573-9696
1760548382 — KAYE PALMER FULCHER MSW, LCSW
Practice Location Address:
6845 FAIRVIEW RD
CHARLOTTE, NC
28210-3363
Practice Phone: 704-364-4333
Practice Fax: 704-969-1175
1548421753 — DR. FRANCES PETTIGREW SNEPP PSY.D.
Practice Location Address:
6845 FAIRVIEW RD
CHARLOTTE, NC
28210-3363
Practice Phone: 704-344-9495
Practice Fax:

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