Provider Demographics
NPI:1982743381
Name:MARKITA FORD
Entity Type:Organization
Organization Name:MARKITA FORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARKITA
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC,LPC, NCC
Authorized Official - Phone:704-408-1882
Mailing Address - Street 1:1235 EAST BLVD # 242
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5870
Mailing Address - Country:US
Mailing Address - Phone:704-408-1882
Mailing Address - Fax:
Practice Address - Street 1:1801 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2704
Practice Address - Country:US
Practice Address - Phone:704-408-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102420Medicaid