Organization
STOUT
Active
Other names
T.B Youth Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE CARSON (PRESIDENT)
(704) 482-0901
Entity
Organization
Contact information
Practice address
605 E GROVER ST, SHELBY, NC 28150-4033
(704) 297-2601
(704) 482-2081
Mailing address
921 N LAFAYETTE ST, SHELBY, NC 28150-3832
(704) 482-0901
(704) 482-2081
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL # 023-043
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL # 023-097
NC
Other
Enumeration date
04/26/2010
Last updated
04/26/2010
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