Omega Rushing Autry, CDMS
Individual provider Active NPI Counselor · Charlotte, NC
NPI 1174900435 · NPPES record last updated May 6, 2015
Key facts
- NPI
- 1174900435
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 00046115 (IL)
- Practice address
- 416 Farmhurst Dr
Charlotte, NC 28217-4923 - Phone
- (704) 523-0021
- Fax
- (704) 523-0809
- NPI assigned
- May 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00046115 | IL | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 00046115 | IL | Yes |
Addresses
Primary practice location
416 Farmhurst Dr
Charlotte, NC 28217-4923
Mailing address
416 Farmhurst Dr
Charlotte, NC 28217-4923
Phone (704) 523-0021
Other providers in Charlotte, NC
- Autism Services of Mecklenburg County, Inc.
- Autism Services of Mecklenburg County, Inc.
- Autism Services of Mecklenburg County, Inc.
- Autism Services of Mecklenburg County, Inc.
- Autism180 LLC
- Autumn Carolina LLC
- Shelby Lee Auvil
- Av Proactive Wellness
- Avalon RX LLC
- Emily Elissa Avalos-Beltran
All providers in Charlotte, NC · Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.