Provider Demographics
NPI:1689733859
Name:STRADER, GEORGE ANN (MS, CSW, LCAS)
Entity Type:Individual
Prefix:MS
First Name:GEORGE
Middle Name:ANN
Last Name:STRADER
Suffix:
Gender:F
Credentials:MS, CSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 UNION RD STE B
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2207
Mailing Address - Country:US
Mailing Address - Phone:704-854-9854
Mailing Address - Fax:704-854-8916
Practice Address - Street 1:1542 UNION RD STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2207
Practice Address - Country:US
Practice Address - Phone:704-854-9854
Practice Address - Fax:704-854-8916
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89101YA0400X
NCA000083104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC44887224OtherUNITED BEHAVIORAL HEALTH
NC5338714OtherAETNA
NC2007264OtherCIGNA BEHAVIORAL HLTH
NC1018FOtherBCBSNC PROVIDER NUMBER