Organization
CLUB SUCCESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BALRIE PARKS M.ED QMHP (EXECUTIVE DIRECTOR)
(980) 213-6400
Entity
Organization
Contact information
Practice address
6004 NUTHATCH CT, CHARLOTTE, NC 28277-5524
(980) 213-6400
Mailing address
6004 NUTHATCH CT, CHARLOTTE, NC 28277-5524
(980) 213-6400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
03/18/2010
Last updated
03/18/2010
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