Provider Demographics
NPI:1386938231
Name:COMMUNITY COUNSELING CENTER
Entity type:Organization
Organization Name:COMMUNITY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:LINELL
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-900-0905
Mailing Address - Street 1:7950 NATIONS FORD RD
Mailing Address - Street 2:STE D4
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-8014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7950 NATIONS FORD RD
Practice Address - Street 2:STE D4
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-8014
Practice Address - Country:US
Practice Address - Phone:704-900-0905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty