| Innovative Community Resources Nc Inc | |
|
5736 N Tryon St Ste 200 Charlotte NC 28213-0820 | |
| (704) 921-6777 | |
| (704) 509-2220 |
| Full Name | Innovative Community Resources Nc Inc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 5736 N Tryon St Ste 200, Charlotte, North Carolina |
| Authorized Official Name and Position | Loretta I Tillman (EXECUTIVE CLINICAL DIRECTOR) |
| Authorized Official Contact | 7049216777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Community Resources Nc Inc 5736 N Tryon St Ste 200 Charlotte NC 28213-0820 Ph: (704) 921-6777 | Innovative Community Resources Nc Inc 5736 N Tryon St Ste 200 Charlotte NC 28213-0820 Ph: (704) 921-6777 |
| NPI Number | 1326249434 |
|---|---|
| Provider Enumeration Date | 05/29/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326249434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 3411 (North Carolina) | Primary |
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