| Innervision Inc. | |
|
1000 Baxter St Charlotte NC 28204-2859 | |
| (704) 377-5047 | |
| (704) 377-5043 |
| Full Name | Innervision Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1000 Baxter St, Charlotte, North Carolina |
| Authorized Official Name and Position | Cheryl Agnes Nicholas (CEO/DIRECTOR) |
| Authorized Official Contact | 7043775047 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innervision Inc. Po Box 31083 Charlotte NC 28231-1083 Ph: (704) 377-5047 | Innervision Inc. 1000 Baxter St Charlotte NC 28204-2859 Ph: (704) 377-5047 |
| NPI Number | 1346505617 |
|---|---|
| Provider Enumeration Date | 07/11/2012 |
| Last Update Date | 07/11/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346505617 | NPI | - | NPPES |
| 8300613 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHL 060 1242 (North Carolina) | Primary |
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