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General NPI Number Information
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NPI Number | 1669493540
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Entity Type | Organization
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Legal Business Name | CLEVELAND PSYCHOSOCIAL SERVICE, INC.
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 809 N LAFAYETTE ST
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City | SHELBY
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State | NC
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Zip | 28150-3978
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Country | US
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Telephone | 704-487-4422
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Fax | 704-487-4304
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Provider Business Mailing Address
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Address Line | 924 N LAFAYETTE ST
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City | SHELBY
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State | NC
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Zip | 28150-3833
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Country | US
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Telephone | 704-482-3370
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Fax | 704-482-3383
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TOMMY GUNN
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Credential |
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Telephone | 704-482-3370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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