| Building Endurance | |
|
1935 J N Pease Pl Ste 104 Charlotte NC 28262-4541 | |
| (980) 288-5486 | |
| Not Available |
| Full Name | Building Endurance |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1935 J N Pease Pl Ste 104, Charlotte, North Carolina |
| Authorized Official Name and Position | Alicia Tetteh (ORGANIZER) |
| Authorized Official Contact | 2022941248 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Building Endurance 1935 J N Pease Pl Ste 104 Charlotte NC 28262-4541 Ph: () - | Building Endurance 1935 J N Pease Pl Ste 104 Charlotte NC 28262-4541 Ph: (980) 288-5486 |
| NPI Number | 1184179087 |
|---|---|
| Provider Enumeration Date | 08/20/2016 |
| Last Update Date | 11/24/2020 |
| Certification Date | 11/24/2020 |
| Medicare PECOS PAC ID | 9436438959 |
|---|---|
| Medicare Enrollment ID | O20161128000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184179087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C010048 (North Carolina) | Primary |
| Provider Name | Alicia Octavia Cobb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417201310 PECOS PAC ID: 4688952666 Enrollment ID: I20170117000749 |
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