MEDICARE: CHRISTIAN FOCUS COUNSELING SERVICE

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	251S00000X	Community/Behavioral Health Agency	MHL-060-257	NC

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

General Provider Information

NPI Number	:	1811040264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN FOCUS COUNSELING SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 189107
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28218-9107
Country	:	US
Telephone Number	:	704-563-9908
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 E INDEPENDENCE BLVD
Second Line	:	SUITE 207
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7485
Country	:	US
Telephone Number	:	704-563-9908
Fax Number	:

Authorized Official
Title or Position	:	EXCUTIVE DIRECTOR
Name	:	WINSTON LASSITER
Credential	:
Telephone Number	:	704-563-9908

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/22/2020

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