Organization
M & M OF THE CAROLINAS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CONSTANCE MICHELLE MONTGOMERY BA, MPA, QP (CEO)
(704) 832-3760
Entity
Organization
Contact information
Practice address
151 BEECHWOOD FARM RD, STATESVILLE, NC 28625-9409
(704) 832-3760
(704) 500-2043
Mailing address
PO BOX 6254, GASTONIA, NC 28056-6023
(704) 832-3760
(704) 500-2043
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TH0100X
Health Service Psychologist
1195
NC
103TM1800X
Intellectual & Developmental Disabilities Psychologist
1332
NC
103TP0814X
Psychoanalysis Psychologist
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409332
—
NC
05
—
6006119
—
NC
05
—
8300866G
—
NC
05
—
8301280
—
NC
05
—
8301280B
—
NC
05
—
CR00088P
—
NC
Enumeration date
08/25/2006
Last updated
12/14/2009
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