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16525 Holly Crest Ln Suite 210 Huntersville NC 28078-4912 | |
| (704) 384-1246 | |
| (704) 384-1249 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 16525 Holly Crest Ln, Huntersville, North Carolina |
| Authorized Official Name and Position | Geoffrey K. Gardner (VP OF FINANCE) |
| Authorized Official Contact | 7043841246 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 60447 Charlotte NC 28260-0447 Ph: (704) 384-1246 | 16525 Holly Crest Ln Suite 210 Huntersville NC 28078-4912 Ph: (704) 384-1246 |
| NPI Number | 1144534942 |
|---|---|
| Provider Enumeration Date | 08/04/2010 |
| Last Update Date | 07/05/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144534942 | NPI | - | NPPES |
| 5915179 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
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