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General NPI Number Information
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NPI Number | 1376866079
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Entity Type | Organization
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Legal Business Name | METROLINA PSYCHOTHERAPY ASSOCIATES P.A.
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 1212 SPRUCE ST. SUITE 315
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City | BELMONT
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State | NC
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Zip | 28012
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Country | US
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Telephone | 704-461-8253
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Fax | 704-461-8267
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Provider Business Mailing Address
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Address Line | 1212 SPRUCE ST. SUITE 315
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City | BELMONT
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State | NC
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Zip | 28012
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Country | US
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Telephone | 704-461-8253
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Fax | 704-461-8267
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHRISTOPHER ANTHONY GAZDIK
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Credential | ATOD, LCSW
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Telephone | 704-461-8253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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