Healthcare Provider Details

I. General information

NPI: 1700087483
Provider Name (Legal Business Name): CAROLINAS PSYCHIATRIC ASSOCIATES CHRISTIAN COUNSELING CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 UNION RD STE C
GASTONIA NC
28054-5523
US

IV. Provider business mailing address

1552 UNION RD STE C
GASTONIA NC
28054-5523
US

V. Phone/Fax

Practice location:
  • Phone: 704-852-9210
  • Fax: 704-852-9211
Mailing address:
  • Phone: 704-852-9210
  • Fax: 704-852-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number200001334296
License Number StateNC

VIII. Authorized Official

Name: DR. PUSHPA CHANDER
Title or Position: PHYSICIAN
Credential: MD
Phone: 704-852-9210