Organization
IMPACT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ADEDOKUN PH.D. (CEO)
(704) 718-3480
Entity
Organization
Contact information
Practice address
3080 JAMESTOWN DR, GASTONIA, NC 28054-6056
(704) 718-3480
(704) 852-4488
Mailing address
3080 JAMESTOWN DR, GASTONIA, NC 28054-6056
(704) 718-3480
(704) 852-4488
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
795
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6111767
—
NC
Enumeration date
08/28/2008
Last updated
08/28/2008
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