Provider Demographics
NPI:1194219147
Name:AT THE HEART OF THE,INC MATTER CHRISTIAN COUNSLEING CENTER INC
Entity Type:Organization
Organization Name:AT THE HEART OF THE,INC MATTER CHRISTIAN COUNSLEING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COWART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,LPCS
Authorized Official - Phone:704-869-8383
Mailing Address - Street 1:2020 REMOUNT RD STE 119
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7476
Mailing Address - Country:US
Mailing Address - Phone:704-869-8383
Mailing Address - Fax:704-675-5038
Practice Address - Street 1:2020 REMOUNT RD STE 119
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7476
Practice Address - Country:US
Practice Address - Phone:704-869-8383
Practice Address - Fax:704-675-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
600025143OtherMAGELLAN HEALTH
NC6103017Medicaid