Organization
CHANGING FAMLIES & LIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHALEEN J GASTON (OWNER)
(980) 213-8589
Entity
Organization
Contact information
Practice address
8517 GALENA VIEW DR, CHARLOTTE, NC 28269-7179
(980) 213-8589
Mailing address
8517 GALENA VIEW DR, CHARLOTTE, NC 28269-7179
(980) 213-8589
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-4580700
—
NC
Enumeration date
07/21/2015
Last updated
07/21/2015
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