Organization
GASTON ADOLESCENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD LAWRENCE HALEY (PRESIDENT/CEO)
(704) 585-8017
Entity
Organization
Contact information
Practice address
635 COX RD STE B, GASTONIA, NC 28054
(704) 691-7561
(704) 691-7563
Mailing address
635 COX RD STE B, GASTONIA, NC 28054-3441
(704) 691-7561
(704) 691-7563
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
A14039
NC
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
MHL-036-274
NC
251S00000X
Community/Behavioral Health Agency
Primary
MHL-036-274
NC
Other
Enumeration date
03/29/2011
Last updated
08/16/2018
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