Provider Demographics
NPI:1609321793
Name:OWENS, TRELONNIE D (BA)
Entity Type:Individual
Prefix:
First Name:TRELONNIE
Middle Name:D
Last Name:OWENS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10949 WILKLEE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2081
Mailing Address - Country:US
Mailing Address - Phone:910-499-1072
Mailing Address - Fax:
Practice Address - Street 1:10949 WILKLEE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2081
Practice Address - Country:US
Practice Address - Phone:910-499-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1228757343900000X
NCL28489101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1228757OtherNORTH CAROLINA DEPARTMENT FO VOCATIONAL REHABILITATION