Individual
MISS PEGGY GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6400 IVORY PALM DR, CHARLOTTE, NC 28227-2435
(704) 910-5458
Mailing address
6400 IVORYPALMDR., CHARLOTTE, NC 28227-2435
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/09/2010
Last updated
12/09/2010
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