Healthcare Provider Details

I. General information

NPI: 1932433893
Provider Name (Legal Business Name): MCWILLIAMS CENTER FOR COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 N MARIETTA ST
GASTONIA NC
28054-7301
US

IV. Provider business mailing address

936 N MARIETTA ST
GASTONIA NC
28054-7301
US

V. Phone/Fax

Practice location:
  • Phone: 704-686-7001
  • Fax: 704-852-4401
Mailing address:
  • Phone: 704-686-7001
  • Fax: 704-852-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TANESHIA MCKINSTRY
Title or Position: CFO
Credential:
Phone: 704-686-7001