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Organization
AUTISM SERVICES OF MECKLENBURG COUNTY, INC.
Active
Organization
AUTISM SERVICES OF MECKLENBURG COUNTY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK MARCELLOUS PHILLIPS JR. MA (EXECUTIVE DIRECTOR/CEO)
(704) 392-9220
Entity
Organization
Contact information
Practice address
5917 ROWAN WAY, CHARLOTTE, NC 28214
(704) 391-5559
(704) 391-5560
Mailing address
2211 EXECUTIVE ST, SUITE A, CHARLOTTE, NC 28208-3661
(704) 392-9220
(704) 392-9221
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-060-514
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406022
—
NC
Enumeration date
10/04/2012
Last updated
01/10/2013
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