Provider Demographics
NPI:1770560732
Name:THE DILWORTH CENTER FOR CHEMICAL DEPENDENCY
Entity type:Organization
Organization Name:THE DILWORTH CENTER FOR CHEMICAL DEPENDENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:ODELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CCAS, CSAC
Authorized Official - Phone:704-372-6969
Mailing Address - Street 1:2240 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5941
Mailing Address - Country:US
Mailing Address - Phone:704-372-6969
Mailing Address - Fax:704-335-0176
Practice Address - Street 1:2240 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5941
Practice Address - Country:US
Practice Address - Phone:704-372-6969
Practice Address - Fax:704-335-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC060-087101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty