Organization
FOOTPRINTS CAROLINA, INC
Active
Other names
Footprints Carolina
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD ANDERSON SR. (EXECUTIVE DIRECTOR)
(704) 884-2500
Entity
Organization
Contact information
Practice address
2020 REMOUNT RD, GASTONIA, NC 28054-7437
(704) 884-2554
(704) 524-2095
Mailing address
917 FIRST ST., SHELBY, NC 28150-3958
(704) 480-6641
(704) 480-1364
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600599
—
NC
05
—
6005996
—
NC
05
—
6005998
—
NC
Enumeration date
08/23/2006
Last updated
12/11/2009
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