Healthcare Provider Details

I. General information

NPI: 1588633929
Provider Name (Legal Business Name): GASTON-LINCOLN-CLEVELAND MENTAL HEALTH SUBSTANCE ABUSE DD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 COURT DR
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

901 S NEW HOPE RD
GASTONIA NC
28054-5829
US

V. Phone/Fax

Practice location:
  • Phone: 704-884-2501
  • Fax: 704-884-2513
Mailing address:
  • Phone: 704-884-2501
  • Fax: 704-884-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. RHETT MELTON
Title or Position: AREA DIRECTOR
Credential: N/A
Phone: 704-842-6328