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9723 Northcross Center Ct Ste L Huntersville NC 28078-7301 | |
| (704) 962-1924 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 9723 Northcross Center Ct Ste L, Huntersville, North Carolina |
| Authorized Official Name and Position | Iris Esther Whitlock (OWNER) |
| Authorized Official Contact | 7049621924 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
13717 Cinnabar Pl Huntersville NC 28078-5342 Ph: (704) 962-1924 | 9723 Northcross Center Ct Ste L Huntersville NC 28078-7301 Ph: (704) 962-1924 |
| NPI Number | 1942716808 |
|---|---|
| Provider Enumeration Date | 12/14/2017 |
| Last Update Date | 07/06/2024 |
| Certification Date | 07/06/2024 |
| Medicare PECOS PAC ID | 8325584857 |
|---|---|
| Medicare Enrollment ID | O20240722000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942716808 | NPI | - | NPPES |
| 10758 | Other | NC | NC BOARD OF LPC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 10758 (North Carolina) | Primary |
| Provider Name | Iris Esther Whitlock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659785319 PECOS PAC ID: 9234675760 Enrollment ID: I20240722000353 |
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