Provider Demographics
NPI:1275834384
Name:RECOVERY CENTER OF THE TRIAD
Entity Type:Organization
Organization Name:RECOVERY CENTER OF THE TRIAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-868-4132
Mailing Address - Street 1:813 S OAKLAND ST
Mailing Address - Street 2:STE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0473
Mailing Address - Country:US
Mailing Address - Phone:704-868-4132
Mailing Address - Fax:704-868-4133
Practice Address - Street 1:813 S OAKLAND ST
Practice Address - Street 2:STE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0473
Practice Address - Country:US
Practice Address - Phone:704-868-4132
Practice Address - Fax:704-868-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health