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General NPI Number Information
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NPI Number | 1639806359
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Entity Type | Organization
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Legal Business Name | ETHOS SERVICES
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 432 E LONG AVE STE 2
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City | GASTONIA
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State | NC
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Zip | 28054-2540
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Country | US
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Telephone | 980-416-3025
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Fax | 980-448-3419
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Provider Business Mailing Address
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Address Line | 432 E LONG AVE STE 2
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City | GASTONIA
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State | NC
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Zip | 28054-2540
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Country | US
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Telephone | 980-416-3025
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Fax | 980-448-3419
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Authorized Official
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Title or Position | CEO
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Name | MR. BENNY LOCKLEAR JR.
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Credential | MSW
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Telephone | 910-964-0678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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Taxonomy #5
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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Taxonomy #6
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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