Provider Demographics
NPI:1184479164
Name:THE 4C COMPANY OF NC, LLC
Entity type:Organization
Organization Name:THE 4C COMPANY OF NC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-394-8968
Mailing Address - Street 1:9805 STATESVILLE RD STE 4305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7647
Mailing Address - Country:US
Mailing Address - Phone:980-245-4437
Mailing Address - Fax:980-245-4704
Practice Address - Street 1:240 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4737
Practice Address - Country:US
Practice Address - Phone:980-781-1051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health