Organization
YOUTH/ADULT CARE MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHON BLACK (EXECUTIVE DIRECTOR)
(704) 933-3505
Entity
Organization
Contact information
Practice address
1605 OLD EARNHARDT RD, KANNAPOLIS, NC 28083-8025
(704) 933-3505
Mailing address
PO BOX 1013, CONCORD, NC 28026-1013
(704) 933-3505
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
10/27/2006
Last updated
08/22/2020
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