Provider Demographics
NPI:1588321244
Name:CHARLOTTE CENTER FOR NEUROPSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:CHARLOTTE CENTER FOR NEUROPSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GANCI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-334-1852
Mailing Address - Street 1:501 S SHARON AMITY RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 S SHARON AMITY RD STE 500
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2897
Practice Address - Country:US
Practice Address - Phone:631-334-1852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty