NPIMap

Organization Active NPI

Autism Services of Mecklenburg Co. Inc.

  • Community/Behavioral Health Agency
  • Charlotte, NC
National Provider Identifier
1689010753
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-060-1083 Issued in NC
Legal business name
AUTISM SERVICES OF MECKLENBURG CO. INC.
Practice address
2223 Executive St
Suite E
Charlotte, NC 28208-3653
Phone
(704) 392-9220
Fax
(704) 392-9221
NPI assigned
May 16, 2013
Last updated
May 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Authorized official

Name
Mr. Jack Marcellous Phillips Jr., MA
Title
Executive Director/Ceo
Phone
(704) 392-9220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL-060-1083 NC Primary

Addresses

Primary practice location

2223 Executive St
Suite E
Charlotte, NC 28208-3653

Mailing address

2211 Executive St Ste a
Charlotte, NC 28208-3655
Phone (704) 392-9220

National Provider Directory

National Provider Directory
Tax ID family
Autism Services of Mecklenburg County Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2211 Executive St
Ste A
Charlotte, NC 28208
Phone (704) 392-9220

2223 Executive St
Ste E
Charlotte, NC 28208
Phone (704) 392-9220

NPI Registry JSON

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

{
    "created_epoch": "1368662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368662400000",
    "number": "1689010753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 EXECUTIVE ST STE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282083655",
            "telephone_number": "704-392-9220",
            "fax_number": "704-392-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 EXECUTIVE ST",
            "address_2": "SUITE E",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282083653",
            "telephone_number": "704-392-9220",
            "fax_number": "704-392-9221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM SERVICES OF MECKLENBURG CO. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-16",
        "last_updated": "2013-05-16",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "MARCELLOUS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/CEO",
        "authorized_official_telephone_number": "704-392-9220",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-060-1083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; 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.