Basic Information
| Provider Information | |||||||||
| NPI: | 1114271434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VROOM | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 SCALEYBARK RD STE B | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282092682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285866600 | ||||||||
| FaxNumber: | 7045366030 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 SCALEYBARK RD STE B | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047161146 | ||||||||
| FaxNumber: | 8285866601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2012 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 9798 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.