Healthcare Provider Details

I. General information

NPI: 1790256394
Provider Name (Legal Business Name): HEART TOHEART WOMEN IN CRISIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2018
Last Update Date: 12/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209B S YORK ST
GASTONIA NC
28052-6127
US

IV. Provider business mailing address

1209B S YORK ST
GASTONIA NC
28052-6127
US

V. Phone/Fax

Practice location:
  • Phone: 704-215-6886
  • Fax: 704-215-6850
Mailing address:
  • Phone: 704-215-6886
  • Fax: 704-215-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY ELIZABETH KENDRICK
Title or Position: CEO
Credential: MS, CSAC, CPSS
Phone: 704-215-6886