NPIMap

Organization Active NPI

Gaston Adolescent Center, Inc.

  • Community/Behavioral Health Agency
  • Gastonia, NC
National Provider Identifier
1316236458
Registry record updated Aug 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-036-274 Issued in NC
Legal business name
GASTON ADOLESCENT CENTER, INC.
Practice address
635 Cox Rd Ste B
Gastonia, NC 28054
Phone
(704) 691-7561
Fax
(704) 691-7563
NPI assigned
Mar 29, 2011
Last updated
Aug 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Edward Lawrence Haley
Title
President/Ceo
Phone
(704) 585-8017

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X A14039 NC
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X MHL-036-274 NC
Community/Behavioral Health Agency 251S00000X MHL-036-274 NC Primary

Addresses

Primary practice location

635 Cox Rd Ste B
Gastonia, NC 28054

Mailing address

635 Cox Rd Ste B
Gastonia, NC 28054-3441
Phone (704) 691-7561

Other practice location 1

1316 Spencer Mountain Rd
Gastonia, NC 28054-3045
Phone (704) 824-3012

National Provider Directory

National Provider Directory

Locations

635 Cox Rd
Ste B
Gastonia, NC 28054
Phone (704) 691-7561

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534377600000",
    "number": "1316236458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 COX RD STE B",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280543441",
            "telephone_number": "704-691-7561",
            "fax_number": "704-691-7563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 COX RD STE B",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "28054",
            "telephone_number": "704-691-7561",
            "fax_number": "704-691-7563"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1316 Spencer Mountain Rd",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280543045",
            "country_code": "US",
            "telephone_number": "704-824-3012",
            "fax_number": "704-691-7563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GASTON ADOLESCENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-29",
        "last_updated": "2018-08-16",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "704-585-8017",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A14039",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": "NC",
            "license": "MHL-036-274",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-036-274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.