Provider Demographics
NPI:1821673070
Name:CHARLOTTE MUSIC THERAPY, LLC
Entity Type:Organization
Organization Name:CHARLOTTE MUSIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MUSIC THERAPIST BOARD CERTIFIED
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:SWIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:704-996-0381
Mailing Address - Street 1:235 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1307
Mailing Address - Country:US
Mailing Address - Phone:704-996-0381
Mailing Address - Fax:
Practice Address - Street 1:725 PROVIDENCE RD STE 332
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2239
Practice Address - Country:US
Practice Address - Phone:704-996-0381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty