Medical Assessment Clinic

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

3547 Issued in NC

Legal business name

MEDICAL ASSESSMENT CLINIC

Practice address

4912 Albemarle Rd
Charlotte, NC 28205-6618

Phone

(980) 229-3722

Fax

(704) 896-8193

NPI assigned

Sep 29, 2012

Last updated

Sep 29, 2012By 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

Ms. Lan Le Bonno Lebozec

Title

President

Phone

(980) 229-3722

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1348876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348876800000",
    "number": "1548511595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4912 ALBEMARLE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282056618",
            "telephone_number": "980-229-3722",
            "fax_number": "704-896-8193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4912 ALBEMARLE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282056618",
            "telephone_number": "980-229-3722",
            "fax_number": "704-896-8193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ASSESSMENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-29",
        "last_updated": "2012-09-29",
        "status": "A",
        "authorized_official_last_name": "BONNO LEBOZEC",
        "authorized_official_first_name": "LAN",
        "authorized_official_middle_name": "LE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "980-229-3722",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "3547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2012; 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.