# ST. MICHAEL'S THERAPEUTIC SERVICES, INC. \#2

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073702429
- **Authorized official:** MS. TASHEEMA YVETTE SHORE BS,QP (OWNER)
- **Authorized official phone:** (704) 701-2582

## Contact information

- **Practice address:** 4477 FAWNBROOK AVE, CONCORD, NC 28027-0412
- **Practice address phone:** (704) 637-3375
- **Practice address fax:** (704) 782-9383
- **Mailing address:** 4477 FAWNBROOK AVE, CONCORD, NC 28027-0412
- **Mailing address phone:** (704) 637-3375
- **Mailing address fax:** (704) 782-9383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-080-163 | NC | Yes |

## Other

- **Enumeration date:** 10/22/2007
- **Last updated:** 10/22/2007