Organization
CAROLINA OUTREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY FITZGERALD MS (INTENSIVE IN-HOME THERAPIST)
(704) 565-9538
Entity
Organization
Contact information
Practice address
5108 REAGAN DR, CHARLOTTE, NC 28206-3103
(704) 332-8787
Mailing address
5108 REAGAN DR, CHARLOTTE, NC 28206-3103
(704) 332-8787
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
06/10/2022
Last updated
06/10/2022
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