MEDICARE: CENTER FOR PREVENTION SERVICES

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		NC

General Provider Information

NPI Number	:	1962776799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR PREVENTION SERVICES

Provider Business Mailing Address
First Line	:	1117 E MOREHEAD ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2895
Country	:	US
Telephone Number	:	704-375-3784
Fax Number	:	704-333-3784

Provider Business Practice Location Address
First Line	:	1117 E MOREHEAD ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2895
Country	:	US
Telephone Number	:	704-375-3784
Fax Number	:	704-333-3784

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. JANE GOBLE-CLARK
Credential	:	MPA, CSAPC
Telephone Number	:	704-375-3784

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	02/24/2012

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Directions to “CENTER FOR PREVENTION SERVICES ” Practice Location

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