| Micum Health Pllc | |
|
10130 Mallard Creek Rd Ste 207 Charlotte NC 28262-6003 | |
| (800) 470-8303 | |
| (704) 997-1588 |
| Full Name | Micum Health Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 10130 Mallard Creek Rd Ste 207, Charlotte, North Carolina |
| Authorized Official Name and Position | Tovakyshe Woullard (PROGRAM DIRECTOR) |
| Authorized Official Contact | 8004708303 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Micum Health Pllc 4311 School House Cmns # 174 Harrisburg NC 28075-7510 Ph: (800) 470-8303 | Micum Health Pllc 10130 Mallard Creek Rd Ste 207 Charlotte NC 28262-6003 Ph: (800) 470-8303 |
| NPI Number | 1376326850 |
|---|---|
| Provider Enumeration Date | 08/17/2023 |
| Last Update Date | 06/20/2024 |
| Certification Date | 06/20/2024 |
| Medicare PECOS PAC ID | 0547607673 |
|---|---|
| Medicare Enrollment ID | O20240325001470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376326850 | NPI | - | NPPES |
| Provider Name | Tovakyshe J Woullard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174142277 PECOS PAC ID: 3971940016 Enrollment ID: I20240325001756 |
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