34D2173939 CLIA NUMBER - INTEGRATED BEHAVIORAL HEALTH MANAGEMENT

Laboratory Demographics

  • CLIA Code: 34D2173939
  • Facility Name: INTEGRATED BEHAVIORAL HEALTH MANAGEMENT
  • Facility Address: 8430 MEDICAL PLAZA DR. SUITE 300
    CHARLOTTE, NC
    ZIP 28262
  • Facility Phone: 704 910-6142
  • Facility Type: Other - BEHAVIORAL HEALTH
  • Facility Type: Waiver
  • Lab Director: MARYANN RICHARDSON
  • NPI Number: 1780033233
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 34D2173939
LAB Type Other - BEHAVIORAL HEALTH
Facility Name INTEGRATED BEHAVIORAL HEALTH MANAGEMENT
Street 8430 MEDICAL PLAZA DR. SUITE 300
City CHARLOTTE
State NC
ZIP 28262
Phone 704 910-6142
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/22/2023
Certificate Expiration Date 10/21/2025
Facility Type Other - BEHAVIORAL HEALTH
Lab Director MARYANN RICHARDSON

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This page was last updated on: 3/20/2025