Individual
KORDARYL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6115 HICKORY GROVE RD, CHARLOTTE, NC 28215-4207
(704) 532-4262
Mailing address
6115 HICKORY GROVE RD, CHARLOTTE, NC 28215-4207
(704) 532-4262
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDAC-22217
NC
Other
Enumeration date
01/28/2020
Last updated
01/28/2020
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