Organization
MY PEACE KEEPER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIRGINIA BEA POUGH PMPQ (PRESIDENT)
(704) 777-2222
Entity
Organization
Contact information
Practice address
7504 E INDEPENDENCE BLVD, SUITE 101, CHARLOTTE, NC 28227-9472
(704) 531-5656
(704) 531-9711
Mailing address
PO BOX 25332, 7504 EAST INDEPENDENCE BLVD. SUITE 101, CHARLOTTE, NC 28227-9407
(704) 531-5656
(704) 531-9711
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/12/2007
Last updated
07/21/2009
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