Provider Demographics
NPI:1497944680
Name:COMMUNITY RESOURCE DEVELOPMENT GROUP
Entity Type:Organization
Organization Name:COMMUNITY RESOURCE DEVELOPMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/QP
Authorized Official - Phone:704-756-3991
Mailing Address - Street 1:1235 EAST BLVD STE 242
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5870
Mailing Address - Country:US
Mailing Address - Phone:704-756-3991
Mailing Address - Fax:
Practice Address - Street 1:1235 EAST BLVD STE 242
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5870
Practice Address - Country:US
Practice Address - Phone:704-756-3991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management