NPIMap

Organization Active NPI

Metrolina Psychotherapy Associates P.a.

  • Clinical Social Worker
  • Belmont, NC
National Provider Identifier
1376866079
Registry record updated Jul 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
METROLINA PSYCHOTHERAPY ASSOCIATES P.A.
Practice address
1212 Spruce St.
Suite 315
Belmont, NC 28012
Phone
(704) 461-8253
Fax
(704) 461-8267
NPI assigned
Mar 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2014

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

Authorized official

Name
Mr. Christopher Anthony Gazdik, ATOD, LCSWNPI 1558309179
Title
President
Phone
(704) 461-8253

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

1212 Spruce St.
Suite 315
Belmont, NC 28012

Mailing address

1212 Spruce St.
Suite 315
Belmont, NC 28012
Phone (704) 461-8253

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100910001094 NC Part B Supplier - Clinic/Group Practice 7113042326 Receives reassigned benefits from 3 practitioners
Practice locations: Mt Holly, NC

National Provider Directory

National Provider Directory

Locations

1212 Spruce St
Ste 315
Belmont, NC 28012
Phone (704) 461-8253

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405987200000",
    "number": "1376866079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 SPRUCE ST.",
            "address_2": "SUITE 315",
            "city": "BELMONT",
            "state": "NC",
            "postal_code": "28012",
            "telephone_number": "704-461-8253",
            "fax_number": "704-461-8267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 SPRUCE ST.",
            "address_2": "SUITE 315",
            "city": "BELMONT",
            "state": "NC",
            "postal_code": "28012",
            "telephone_number": "704-461-8253",
            "fax_number": "704-461-8267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METROLINA PSYCHOTHERAPY ASSOCIATES P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-09",
        "last_updated": "2014-07-22",
        "status": "A",
        "authorized_official_last_name": "GAZDIK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-461-8253",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATOD, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belmont, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.