Provider Demographics
NPI:1467542134
Name:CHILDREN'S HOMES OF CLEVELAND COUNTY
Entity Type:Organization
Organization Name:CHILDREN'S HOMES OF CLEVELAND COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:704-484-2558
Mailing Address - Street 1:PO BOX 2053
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-2053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300C GIDNEY ST.
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-484-2558
Practice Address - Fax:704-484-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005965Medicaid