Provider Demographics
NPI:1700087483
Name:CAROLINAS PSYCHIATRIC ASSOCIATES CHRISTIAN COUNSELING CLINIC PA
Entity Type:Organization
Organization Name:CAROLINAS PSYCHIATRIC ASSOCIATES CHRISTIAN COUNSELING CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PUSHPA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-852-9210
Mailing Address - Street 1:1552 UNION RD STE C
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5523
Mailing Address - Country:US
Mailing Address - Phone:704-852-9210
Mailing Address - Fax:704-852-9211
Practice Address - Street 1:1552 UNION RD STE C
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5523
Practice Address - Country:US
Practice Address - Phone:704-852-9210
Practice Address - Fax:704-852-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001334296173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0201NOtherBLUE CROSS BLUE SHIELD
NC890201NMedicaid
NC890201NMedicaid
NC2335933Medicare PIN