Healthcare Provider Details

I. General information

NPI: 1639329923
Provider Name (Legal Business Name): GASTON SKILLS, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BESSEMER CITY RD
GASTONIA NC
28052-1106
US

IV. Provider business mailing address

1301 BESSEMER CITY RD
GASTONIA NC
28052-1106
US

V. Phone/Fax

Practice location:
  • Phone: 704-869-0300
  • Fax: 704-869-9594
Mailing address:
  • Phone: 704-869-0300
  • Fax: 704-869-9594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC001582
License Number StateNC

VIII. Authorized Official

Name: MISS JOANN RAXTER
Title or Position: INTERM EXECUTIVE DIRECTOR
Credential:
Phone: 704-869-0300