|
| |
|
124 E Plaza Dr Ste C Mooresville NC 28115-8103 | |
| (704) 228-3775 | |
| (800) 708-8044 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 124 E Plaza Dr Ste C, Mooresville, North Carolina |
| Authorized Official Name and Position | Sadia Upright (OWNER) |
| Authorized Official Contact | 7042283775 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5501 Executive Center Dr Ste 232 Charlotte NC 28212-8892 Ph: (980) 875-8468 | 124 E Plaza Dr Ste C Mooresville NC 28115-8103 Ph: (704) 228-3775 |
| NPI Number | 1073092524 |
|---|---|
| Provider Enumeration Date | 08/07/2018 |
| Last Update Date | 01/08/2025 |
| Certification Date | 01/08/2025 |
| Medicare PECOS PAC ID | 3779811229 |
|---|---|
| Medicare Enrollment ID | O20190822001272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073092524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | A13063 (North Carolina) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Delores Estelle Burrill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750532461 PECOS PAC ID: 6204127087 Enrollment ID: I20160627000259 |
Wellness Psychiatry Group, P.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 249 Williamson Rd, Suite 102, Mooresville, NC 28117 Phone: 704-912-7037 | |
Pinnacle Performance Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 816 Brawley School Rd Ste F1, Mooresville, NC 28117 Phone: 704-799-1270 Fax: 704-799-1271 | |
Kristin Leigh Matas Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 107 Kilson Dr Ste 202, Mooresville, NC 28117 Phone: 704-302-6974 | |
The Center At Lake Norman Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 132 Joe Knox Ave Ste 100, Mooresville, NC 28117 Phone: 704-980-9234 Fax: 866-321-9367 | |