Provider Demographics
NPI:1689978686
Name:GREATER METROLINA MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:GREATER METROLINA MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-865-5613
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-0219
Mailing Address - Country:US
Mailing Address - Phone:704-865-5613
Mailing Address - Fax:704-865-5614
Practice Address - Street 1:609 S NEW HOPE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4876
Practice Address - Country:US
Practice Address - Phone:704-865-5613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410160Medicaid
NC8703161Medicaid
NC6005583Medicaid