Organization
CHARLOTTE CDSA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONSTANCE COOK MELE PMHCNS-BC,CARN-AP (DIRECTOR OF PROVIDED SERVICES)
(704) 336-7155
Entity
Organization
Contact information
Practice address
3500 ELLINGTON ST, CARLTON WATKINS CENTER, CHARLOTTE, NC 28211-1102
(704) 336-7107
(704) 336-7110
Mailing address
3500 ELLINGTON ST, CARLTON WATKINS CENTER, CHARLOTTE, NC 28211-1102
(704) 336-7107
(704) 336-7110
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3403416
NC HEALTH CHOICE
NC
05
—
3403416
—
NC
Enumeration date
04/03/2013
Last updated
04/03/2013
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