Gloria Crandell-Nelson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

GLORIA CRANDELL-NELSON

Practice address

7356 US Highway 64
Robersonville, NC 27871-9073

Phone

(252) 795-6662

Fax

(252) 795-6696

NPI assigned

Apr 9, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Gloria Crandell-Nelson

Title

Ceo

Phone

(252) 795-6662

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Shadows Community Support Center Doing business as

Tax ID family

Gloria Crandell-Nelson2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Shadows Community Support Center LLC

  • Clinical Social Worker
  • Robersonville, NC
  • NPI 1487819363
  NPD tax ID

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279584000000",
    "number": "1700909454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7356 HWY 64 E",
            "city": "ROBERSONVILLE",
            "state": "NC",
            "postal_code": "278710278",
            "telephone_number": "252-795-6662",
            "fax_number": "252-795-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7356 US HIGHWAY 64",
            "city": "ROBERSONVILLE",
            "state": "NC",
            "postal_code": "278719073",
            "telephone_number": "252-795-6662",
            "fax_number": "252-795-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLORIA CRANDELL-NELSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2010-07-20",
        "status": "A",
        "authorized_official_last_name": "CRANDELL-NELSON",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-795-6662",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006991",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950083",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301939",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shadows Community Support Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lisa Gennosa, PA-C
• Thomas Joseph Gennosa, MD
• Cathy Griffin
• Healthfirst Wellness Center, PLLC
• Suzanne Williams Holland, FNP-C
• Trinea Jones
• Henry Albert Kearney III, D.D.S.

• All providers in Robersonville, NC
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; 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.