Organization
ST. MICHAEL'S THERAPEUTIC SERVICES, INC. #2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TASHEEMA YVETTE SHORE BS,QP (OWNER)
(704) 701-2582
Entity
Organization
Contact information
Practice address
4477 FAWNBROOK AVE, CONCORD, NC 28027-0412
(704) 637-3375
(704) 782-9383
Mailing address
4477 FAWNBROOK AVE, CONCORD, NC 28027-0412
(704) 637-3375
(704) 782-9383
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-080-163
NC
Other
Enumeration date
10/22/2007
Last updated
10/22/2007
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