Provider Demographics
NPI:1386846756
Name:PEACFUL ALTERNATIVE RESOURCES,INC
Entity Type:Organization
Organization Name:PEACFUL ALTERNATIVE RESOURCES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:BA,QMHP,QDDP,QSAC
Authorized Official - Phone:704-944-3100
Mailing Address - Street 1:10925 DAVID TAYLOR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1044
Mailing Address - Country:US
Mailing Address - Phone:704-944-3100
Mailing Address - Fax:704-944-3101
Practice Address - Street 1:10925 DAVID TAYLOR DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1044
Practice Address - Country:US
Practice Address - Phone:704-944-3100
Practice Address - Fax:704-944-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1663101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107028Medicaid