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General NPI Number Information
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NPI Number | 1740171255
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Entity Type | Organization
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Legal Business Name | LEDBETTER RECOVERY SERVICES. LLC
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Dates
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Enumeration Date | 07/12/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 310 W THIRD AVE
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City | GASTONIA
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State | NC
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Zip | 28052-4004
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Country | US
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Telephone | 704-868-8644
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Fax |
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Provider Business Mailing Address
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Address Line | 2015 DONEGAL CT
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City | GASTONIA
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State | NC
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Zip | 28054-6702
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Country | US
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Telephone | 980-474-0117
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MELISSA WAGNER
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Credential | LCAS
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Telephone | 980-474-0117
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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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