Provider Demographics
NPI:1396814331
Name:MECKLENBURG COUNTY
Entity Type:Organization
Organization Name:MECKLENBURG COUNTY
Other - Org Name:MECKLENBURG COUNTY CHILDREN'S DEVELOPMENTAL SERVICES AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYNARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:980-579-0671
Mailing Address - Street 1:700 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2886
Mailing Address - Country:US
Mailing Address - Phone:980-314-8640
Mailing Address - Fax:
Practice Address - Street 1:3205 FREEDOM DR STE 7500
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3490
Practice Address - Country:US
Practice Address - Phone:704-336-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396814331Medicaid
NC3403416Medicaid