Provider Demographics
NPI:1023259975
Name:MECKLENBURG COUNTY AREA MENTAL HEALTH
Entity type:Organization
Organization Name:MECKLENBURG COUNTY AREA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRAYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-336-8638
Mailing Address - Street 1:PO BOX 221269
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28222-1269
Mailing Address - Country:US
Mailing Address - Phone:704-336-7160
Mailing Address - Fax:704-336-8591
Practice Address - Street 1:3430 WHEATLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7654
Practice Address - Country:US
Practice Address - Phone:704-336-2227
Practice Address - Fax:704-353-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty