Provider Demographics
NPI:1982956074
Name:MECKLENBURG COUNTY AREA MENTAL HEALTH AUTHORITY
Entity Type:Organization
Organization Name:MECKLENBURG COUNTY AREA MENTAL HEALTH AUTHORITY
Other - Org Name:SUBSTANCE ABUSE SERVICES CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:MELE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHCNS-BC,CARN-AP
Authorized Official - Phone:704-336-7155
Mailing Address - Street 1:429 BILLINGSLEY RD
Mailing Address - Street 2:SAM BILLINGS CENTER
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1007
Mailing Address - Country:US
Mailing Address - Phone:704-336-3067
Mailing Address - Fax:704-336-5105
Practice Address - Street 1:429 BILLINGSLEY RD
Practice Address - Street 2:SAM BILLINGS CENTER
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1007
Practice Address - Country:US
Practice Address - Phone:704-336-3067
Practice Address - Fax:704-336-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251K00000X
NCMHL-060-185324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251K00000XAgenciesPublic Health or Welfare