Organization
INNOVATIVE COMMUNITY RESOURCES NC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORETTA I TILLMAN MA (EXECUTIVE CLINICAL DIRECTOR)
(704) 921-6777
Entity
Organization
Contact information
Practice address
5736 N TRYON ST STE 200, CHARLOTTE, NC 28213-0820
(704) 921-6777
(704) 509-2220
Mailing address
5736 N TRYON ST STE 200, CHARLOTTE, NC 28213-0820
(704) 921-6777
(704) 509-2220
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3411
NC
Other
Enumeration date
05/29/2007
Last updated
08/22/2020
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