Provider Demographics
NPI:1376866079
Name:METROLINA PSYCHOTHERAPY ASSOCIATES P.A.
Entity Type:Organization
Organization Name:METROLINA PSYCHOTHERAPY ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GAZDIK
Authorized Official - Suffix:
Authorized Official - Credentials:ATOD, LCSW
Authorized Official - Phone:704-461-8253
Mailing Address - Street 1:1212 SPRUCE ST.
Mailing Address - Street 2:SUITE 315
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012
Mailing Address - Country:US
Mailing Address - Phone:704-461-8253
Mailing Address - Fax:704-461-8267
Practice Address - Street 1:1212 SPRUCE ST.
Practice Address - Street 2:SUITE 315
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012
Practice Address - Country:US
Practice Address - Phone:704-461-8253
Practice Address - Fax:704-461-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty