Provider Demographics
NPI:1588633929
Name:GASTON-LINCOLN-CLEVELAND MENTAL HEALTH SUBSTANCE ABUSE DD
Entity Type:Organization
Organization Name:GASTON-LINCOLN-CLEVELAND MENTAL HEALTH SUBSTANCE ABUSE DD
Other - Org Name:PATHWAYS MHDDSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:704-842-6328
Mailing Address - Street 1:901 S NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5829
Mailing Address - Country:US
Mailing Address - Phone:704-884-2501
Mailing Address - Fax:704-884-2513
Practice Address - Street 1:2505 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-884-2501
Practice Address - Fax:704-884-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404910Medicaid
NC280004Medicare ID - Type UnspecifiedMEDICARE-MD
NC2868653Medicare ID - Type UnspecifiedMEDICARE-LCSW
NC3404910Medicaid