Provider Demographics
NPI:1487787040
Name:FLORENCE CRITTENTON SERVICES
Entity type:Organization
Organization Name:FLORENCE CRITTENTON SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:GAITHER
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:704-372-4663
Mailing Address - Street 1:PO BOX 36392
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6392
Mailing Address - Country:US
Mailing Address - Phone:704-372-4663
Mailing Address - Fax:704-334-8167
Practice Address - Street 1:1300 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5873
Practice Address - Country:US
Practice Address - Phone:704-372-4663
Practice Address - Fax:704-334-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005843Medicaid