Provider Demographics
NPI:1376578757
Name:CALVARY PRESBYTERIAN CHURCH OF CHARLOTTE
Entity Type:Organization
Organization Name:CALVARY PRESBYTERIAN CHURCH OF CHARLOTTE
Other - Org Name:LIGHTHOUSE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANDEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-341-5330
Mailing Address - Street 1:5801 PINEVILLE-MATTHEWS ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-341-5326
Mailing Address - Fax:704-341-5454
Practice Address - Street 1:5801 PINEVILLE-MATTHEWS ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-341-5326
Practice Address - Fax:704-341-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)