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Organization
UNIVERSAL INSTITUTE FOR SUCCESSFUL AGING OF CAROLINAS
Active
Organization
UNIVERSAL INSTITUTE FOR SUCCESSFUL AGING OF CAROLINAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHA SIMMONS (DIRECTOR)
(704) 390-4241
Entity
Organization
Contact information
Practice address
7701 WALLACE LN, CHARLOTTE, NC 28212-6427
(704) 390-4241
Mailing address
7701 WALLACE LN, CHARLOTTE, NC 28212-6427
(704) 390-4241
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103TA0700X
Adult Development & Aging Psychologist
Primary
—
NULL
103TA0700X
Adult Development & Aging Psychologist
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
NULL
Other
Enumeration date
01/17/2019
Last updated
01/17/2019
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