34D2159351 CLIA NUMBER - CHARLOTTE TREATMENT CENTER

Laboratory Demographics

CLIA Number: 34D2159351

Facility Name: CHARLOTTE TREATMENT CENTER

Facility Address:
3315 WILKINSON BOULEVARD
CHARLOTTE, NC
ZIP 28208
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Facility Phone Number: 704 697-0044

Facility Type: Other - OP OPIOID TREATMENT CNTR

Certificate Type: Waiver

NPI Number: 1174739403

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	34D2159351
LAB Type	Other - OP OPIOID TREATMENT CNTR
Facility Name	CHARLOTTE TREATMENT CENTER
Street	3315 WILKINSON BOULEVARD
City	CHARLOTTE
State	NC
ZIP	28208
Phone	704 697-0044
CertificateType	4
CertificateEffectiveDate	12/18/2022
CertificateExpirationDate	12/17/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024