Organization
INNERVISION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHERYL AGNES NICHOLAS PHD (CEO/DIRECTOR)
(704) 377-5047
Entity
Organization
Contact information
Practice address
1000 BAXTER ST, CHARLOTTE, NC 28204-2859
(704) 377-5047
(704) 377-5043
Mailing address
PO BOX 31083, CHARLOTTE, NC 28231-1083
(704) 377-5047
(704) 377-5043
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL 060 1242
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300613
—
NC
Enumeration date
07/11/2012
Last updated
07/11/2012
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