NPIMap

Organization Active NPI

Youth/Adult Care Management

  • Clinical Psychologist
  • Kannapolis, NC
National Provider Identifier
1952487522
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
YOUTH/ADULT CARE MANAGEMENT
Practice address
1605 Old Earnhardt Rd
Kannapolis, NC 28083-8025
Phone
(704) 933-3505
NPI assigned
Oct 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Chon Black
Title
Executive Director
Phone
(704) 933-3505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X NU Primary

Addresses

Primary practice location

1605 Old Earnhardt Rd
Kannapolis, NC 28083-8025

Mailing address

PO Box 1013
Concord, NC 28026-1013
Phone (704) 933-3505

National Provider Directory

National Provider Directory
Tax ID family
Youth Adult Care Management16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952487522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1013",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280261013",
            "telephone_number": "704-933-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 OLD EARNHARDT RD",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280838025",
            "telephone_number": "704-933-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH/ADULT CARE MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "CHON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-933-3505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kannapolis, NC

Sources for this page

  • 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.