Organization
INREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI A GOUGEON BS (PRESIDENT)
(704) 536-6661
Entity
Organization
Contact information
Practice address
520 CLANTON RD STE A, CHARLOTTE, NC 28217-1391
(704) 536-6661
Mailing address
4014 MONROE RD STE 170, CHARLOTTE, NC 28205-0094
(704) 536-6661
(704) 536-0074
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
MHL-060-1204
NC
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408799
—
NC
01
—
MHL-060-1204
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES
NC
Enumeration date
10/06/2015
Last updated
03/27/2025
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