Organization
ACCEPTWC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLAN WITHERSPOON (DIRECTOR)
(704) 607-4220
Entity
Organization
Contact information
Practice address
2600 W TRADE ST, CHARLOTTE, NC 28208-3245
(704) 607-4220
Mailing address
2201 ROZZELLES FERRY RD, CHARLOTTE, NC 28208-4236
(704) 607-4220
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
NC
106H00000X
Marriage & Family Therapist
—
NC
106S00000X
Behavior Technician
—
NC
146D00000X
Personal Emergency Response Attendant
—
NC
171W00000X
Contractor
Primary
—
NC
172A00000X
Driver
—
NC
172V00000X
Community Health Worker
—
NC
174200000X
Meals Provider
—
NC
174H00000X
Health Educator
—
NC
225600000X
Dance Therapist
—
NC
225800000X
Recreation Therapist
—
NC
226000000X
Recreational Therapist Assistant
—
NC
374U00000X
Home Health Aide
—
NC
Other
Enumeration date
06/28/2018
Last updated
06/28/2018
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