Provider Demographics
NPI:1144349630
Name:CATHOLIC CHARITIES DIOCESE OF CHARLOTEE
Entity type:Organization
Organization Name:CATHOLIC CHARITIES DIOCESE OF CHARLOTEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-370-3233
Mailing Address - Street 1:1123 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4003
Mailing Address - Country:US
Mailing Address - Phone:704-370-3262
Mailing Address - Fax:704-370-3377
Practice Address - Street 1:1123 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4003
Practice Address - Country:US
Practice Address - Phone:704-370-3262
Practice Address - Fax:704-370-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0253JOtherBCBS
NC0253JOtherBLUECROSS BLUESHIELD
NC6005378Medicaid