Organization
AUTISM SERVICES OF MECKLENBURG CO. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK MARCELLOUS PHILLIPS MA (EXECUTIVE DIRECTOR/CEO)
(704) 392-9220
Entity
Organization
Contact information
Practice address
5215 PINEBROOK DR, CHARLOTTE, NC 28208-2437
(704) 392-9220
(704) 392-9221
Mailing address
2211 EXECUTIVE ST STE A, CHARLOTTE, NC 28208-3655
(704) 392-9220
(704) 392-9221
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-060-166
NC
Other
Enumeration date
05/17/2013
Last updated
05/17/2013
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