Organization · NPI-2

612 Behavioral And Community Services

Community/Behavioral Health · Gastonia, NC

NPI number1336333129
StatusActive
Last updated in NPPESSep 5, 2007

Details

NPI
1336333129
Entity type
Organization (NPI-2)
Legal business name
612 Behavioral And Community Services
Organization subpart
No
Enumeration date
Sep 5, 2007
Last updated
Sep 5, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251S00000X Community/Behavioral Health––Yes

Practice location

2559 Quail Ridge Dr
Gastonia, NC 28056-9205

Phone 704-674-5455

Mailing address

2559 Quail Ridge Dr
Gastonia, NC 28056-9205

Phone 704-674-5455

Authorized official

Demise Lamaar Williams
Ceo
7046745455

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