Innovative Community Resources NC Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3411 Issued in NC

Legal business name

INNOVATIVE COMMUNITY RESOURCES NC INC

Practice address

5736 N Tryon St Ste 200
Charlotte, NC 28213-0820

Phone

(704) 921-6777

Fax

(704) 509-2220

NPI assigned

May 29, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Loretta I Tillman, MANPI 1356495402

Title

Executive Clinical Director

Phone

(704) 921-6777

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Loretta I. Tillman, MA

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1356495402
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326249434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5736 N TRYON ST STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282130820",
            "telephone_number": "704-921-6777",
            "fax_number": "704-509-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5736 N TRYON ST STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282130820",
            "telephone_number": "704-921-6777",
            "fax_number": "704-509-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE COMMUNITY RESOURCES NC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "EXECUTIVE CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "704-921-6777",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "3411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.