Basic Information
| Provider Information | |||||||||
| NPI: | 1598210908 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINAS HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 MOREHEAD MEDICAL DR | ||||||||
| Address2: | STE 2300 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804422000 | ||||||||
| FaxNumber: | 9804422002 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 MOREHEAD MEDICAL DR | ||||||||
| Address2: | STE 2300 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804422000 | ||||||||
| FaxNumber: | 9804422002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2016 | ||||||||
| LastUpdateDate: | 08/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | HENSHAW | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENETIC COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 9804422000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Genetic Counselor, MS |
No ID Information.