Healthcare Provider Details

I. General information

NPI: 1427495209
Provider Name (Legal Business Name): GHA AUTISM SUPPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LINWOOD DRIVE
ALBEMARLE NC
28001-2923
US

IV. Provider business mailing address

PO BOX 2487
ALBEMARLE NC
28002-2487
US

V. Phone/Fax

Practice location:
  • Phone: 704-982-9600
  • Fax: 704-982-8155
Mailing address:
  • Phone: 704-982-9600
  • Fax: 704-982-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL084030
License Number StateNC

VIII. Authorized Official

Name: MRS. DAWN HARWOOD ALLEN
Title or Position: CEO
Credential:
Phone: 704-982-9600