Provider Demographics
NPI:1003612805
Name:MAKE MEMOREZ CC INC
Entity type:Organization
Organization Name:MAKE MEMOREZ CC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-350-1893
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-0094
Mailing Address - Country:US
Mailing Address - Phone:704-966-9410
Mailing Address - Fax:
Practice Address - Street 1:509 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-1501
Practice Address - Country:US
Practice Address - Phone:704-966-9410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty