# AUTISM SERVICES OF MECKLENBURG COUNTY, INC.

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

## Provider details

- **NPI number:** 1477805745
- **Authorized official:** MR. JACK MARCELLOUS PHILLIPS JR. MA (EXECUTIVE DIRECTOR/CEO)
- **Authorized official phone:** (704) 392-9220

## Contact information

- **Practice address:** 4016 PINEY GROVE RD, CHARLOTTE, NC 28212-9012
- **Practice address phone:** (704) 568-4868
- **Mailing address:** 2211 EXECUTIVE ST, SUITE A, CHARLOTTE, NC 28208-3661
- **Mailing address phone:** (704) 392-9220
- **Mailing address fax:** (704) 392-9221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 060-908 | NC | Yes |

## Other

- **Enumeration date:** 10/10/2012
- **Last updated:** 10/10/2012