Provider Demographics
NPI:1205094349
Name:SURRENDER HOUSE OF LINCOLNTON, INC
Entity type:Organization
Organization Name:SURRENDER HOUSE OF LINCOLNTON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, QSAP, SAC-I
Authorized Official - Phone:704-748-9906
Mailing Address - Street 1:PO BOX 1992
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093-1992
Mailing Address - Country:US
Mailing Address - Phone:704-748-9906
Mailing Address - Fax:
Practice Address - Street 1:322 MCBEE ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2819
Practice Address - Country:US
Practice Address - Phone:704-748-9906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL055106324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility