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General NPI Number Information
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NPI Number | 1689752651
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Entity Type | Organization
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Legal Business Name | CAROLINA CENTER FOR COUNSELING & CLINICAL SERVICES, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 227 WILMOT DR
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City | GASTONIA
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State | NC
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Zip | 28054-4048
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Country | US
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Telephone | 704-861-2234
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Fax | 704-861-2235
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Provider Business Mailing Address
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Address Line | PO BOX 550178
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City | GASTONIA
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State | NC
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Zip | 28055-0178
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Country | US
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Telephone | 704-861-2234
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Fax | 704-861-2235
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Authorized Official
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Title or Position | FINANCE DIRECTOR
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Name | MRS. LYNN HAMMONTREE
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Credential | BA
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Telephone | 704-861-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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