Organization
FOOTPRINTS CAROLINA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD ANDERSON SR. (EXECUTIVE DIRECTOR)
(704) 884-2500
Entity
Organization
Contact information
Practice address
2020 REMOUNT RD, GASTONIA, NC 28054-7437
(704) 524-2009
(704) 524-2095
Mailing address
5700 EXECUTIVE CENTER DR STE 100, CHARLOTTE, NC 28212-8833
(704) 566-3460
(704) 566-3461
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005997
—
NC
Enumeration date
08/23/2006
Last updated
12/08/2009
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