Healthcare Provider Details

I. General information

NPI: 1134206212
Provider Name (Legal Business Name): AAA CARE AND TREATMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S COLUMBIA ST
GASTONIA NC
28054-0450
US

IV. Provider business mailing address

306 S COLUMBIA ST
GASTONIA NC
28054-0450
US

V. Phone/Fax

Practice location:
  • Phone: 704-868-2136
  • Fax: 704-868-2175
Mailing address:
  • Phone: 704-868-2136
  • Fax: 704-868-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5042
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003757
License Number StateNC

VIII. Authorized Official

Name: MR. ERNEST B. RUSHING
Title or Position: DIRECTOR
Credential: QDDP,QMHP,QSAP
Phone: 704-868-2136