Provider Demographics
NPI:1851696603
Name:GREATER CHARLOTTE BEHAVIORAL, LLC
Entity Type:Organization
Organization Name:GREATER CHARLOTTE BEHAVIORAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-597-7900
Mailing Address - Street 1:8815 UNIVERSITY EAST DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4100
Mailing Address - Country:US
Mailing Address - Phone:704-597-7900
Mailing Address - Fax:704-597-7990
Practice Address - Street 1:8815 UNIVERSITY EAST DR
Practice Address - Street 2:SUITE 115
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4100
Practice Address - Country:US
Practice Address - Phone:704-597-7900
Practice Address - Fax:704-597-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)