Provider Demographics
NPI:1639247026
Name:GASTON-LIMCON-CLEVELAND MENTAL HEALTH
Entity Type:Organization
Organization Name:GASTON-LIMCON-CLEVELAND MENTAL HEALTH
Other - Org Name:PATHWAYS MENTAL HEALTH
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:
Authorized Official - Phone:704-867-2361
Mailing Address - Street 1:2116 HELEN DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1934
Mailing Address - Country:US
Mailing Address - Phone:704-865-5898
Mailing Address - Fax:
Practice Address - Street 1:901 S NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5829
Practice Address - Country:US
Practice Address - Phone:704-867-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91101YP2500X
NCC0011321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC91OtherLPC
NCC001132OtherLCSW
NCC001132OtherLCSW