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General NPI Number Information
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NPI Number | 1700087483
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Entity Type | Organization
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Legal Business Name | CAROLINAS PSYCHIATRIC ASSOCIATES CHRISTIAN COUNSELING CLINIC PA
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 01/31/2011
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Provider Practice Location Address
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Address Line | 1552 UNION RD STE C
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City | GASTONIA
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State | NC
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Zip | 28054-5523
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Country | US
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Telephone | 704-852-9210
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Fax | 704-852-9211
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Provider Business Mailing Address
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Address Line | 1552 UNION RD STE C
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City | GASTONIA
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State | NC
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Zip | 28054-5523
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Country | US
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Telephone | 704-852-9210
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Fax | 704-852-9211
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PUSHPA CHANDER
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Credential | MD
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Telephone | 704-852-9210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 200001334296
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License Number State | NC
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