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13815 Professional Center Dr Suite 100 And 200 Huntersville NC 28078-7951 | |
| (704) 384-1246 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 13815 Professional Center Dr, Huntersville, North Carolina |
| Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
| Authorized Official Contact | 7043166081 |
| 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 | 13815 Professional Center Dr Suite 100 And 200 Huntersville NC 28078-7951 Ph: (704) 384-1246 |
| NPI Number | 1407306194 |
|---|---|
| Provider Enumeration Date | 10/06/2016 |
| Last Update Date | 06/20/2024 |
| Certification Date | 06/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407306194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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