| Adult Homeless Substance Abuse Treatment-offsite (men's) | |
|
1210 N Tryon St Charlotte NC 28206-3256 | |
| (704) 336-6615 | |
| (704) 423-2421 |
| Full Name | Adult Homeless Substance Abuse Treatment-offsite (men's) |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1210 N Tryon St, Charlotte, North Carolina |
| Authorized Official Name and Position | Grayce Crockett (AREA DIRECTOR) |
| Authorized Official Contact | 7043368638 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Adult Homeless Substance Abuse Treatment-offsite (men's) 429 Billingsley Rd Charlotte NC 28211-1007 Ph: (704) 336-2023 | Adult Homeless Substance Abuse Treatment-offsite (men's) 1210 N Tryon St Charlotte NC 28206-3256 Ph: (704) 336-6615 |
| NPI Number | 1003998212 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003998212 | NPI | - | NPPES |
| 8301099P | Medicaid | NC | |
| 8301099G | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHL-060-144 (North Carolina) | Primary |
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