MEDICARE: CT18 GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1962168815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CT18 GROUP LLC

Provider Business Mailing Address
First Line	:	318 S SOUTH ST STE 8
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4379
Country	:	US
Telephone Number	:	910-331-5209
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 S SOUTH ST STE 8
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4379
Country	:	US
Telephone Number	:	910-331-5209
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER DANIEL TERRY
Credential	:	ESQ
Telephone Number	:	910-331-5209

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	02/25/2022

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