Provider Demographics
NPI:1619168127
Name:GLADYS J MANNAS-STEVENS
Entity Type:Organization
Organization Name:GLADYS J MANNAS-STEVENS
Other - Org Name:PINNACLE GROUP CHILD & FAMILY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MANNASSTEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-537-0885
Mailing Address - Street 1:5817 COOPERS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1032
Mailing Address - Country:US
Mailing Address - Phone:704-947-2278
Mailing Address - Fax:
Practice Address - Street 1:4822 ALBEMARLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6668
Practice Address - Country:US
Practice Address - Phone:704-537-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003723Medicaid