Healthcare Provider Details

I. General information

NPI: 1639247026
Provider Name (Legal Business Name): GASTON-LIMCON-CLEVELAND MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S NEW HOPE RD
GASTONIA NC
28054-5829
US

IV. Provider business mailing address

2116 HELEN DR
GASTONIA NC
28054-1934
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-2361
  • Fax:
Mailing address:
  • Phone: 704-865-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number91
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001132
License Number StateNC

VIII. Authorized Official

Name: MR. RHETT MELTON
Title or Position: AREA DIRECTOR
Credential:
Phone: 704-867-2361