Provider Demographics
NPI:1609946953
Name:MECKLENBURG COUNTY
Entity Type:Organization
Organization Name:MECKLENBURG COUNTY
Other - Org Name:MECKLENBURG COUNTY COMMUNITY SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUBSTANCE USE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHINITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIGHEAD-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, LCAS, CCS
Authorized Official - Phone:704-816-0260
Mailing Address - Street 1:3205 FREEDOM DR STE 2000
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3486
Mailing Address - Country:US
Mailing Address - Phone:704-816-0260
Mailing Address - Fax:
Practice Address - Street 1:1210 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-3256
Practice Address - Country:US
Practice Address - Phone:704-816-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005609Medicaid