Organization
ICHEP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAKA ABDUL MOUSTAFA I PH.D (CEO)
(803) 477-7928
Entity
Organization
Contact information
Practice address
9635 SOUTHERN PINE BLVD STE 126, CHARLOTTE, NC 28273-5558
(803) 477-7928
Mailing address
9635 SOUTHERN PINE BLVD, SUITE 126, CHARLOTTE, NC 28273-5558
(803) 477-7928
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/30/2008
Last updated
03/14/2012
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