Collytte Diana Cederstrom

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

609 S New Hope Rd Ste 102
Gastonia, NC 28054-4825

Phone

(704) 208-1865

Fax

(704) 208-1865

NPI assigned

Jun 15, 2021

Last updated

Jun 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Collytte Diana Medders Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New Hope Counseling and Wellness LLC

  • Professional Counselor
  • Gastonia, NC
  • NPI 1245607514
  NPD

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1770151888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 HAMILTONS BAY CT APT 506",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297109040",
            "telephone_number": "803-242-2082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 S NEW HOPE RD STE 102",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544825",
            "telephone_number": "704-208-1865",
            "fax_number": "704-208-1865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Hamiltons Bay Ct Apt 506",
            "address_purpose": "LOCATION",
            "city": "Lake Wylie",
            "state": "SC",
            "postal_code": "297109040",
            "country_code": "US",
            "telephone_number": "803-242-2082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CEDERSTROM",
        "first_name": "COLLYTTE",
        "middle_name": "DIANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-15",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLYTTE",
            "last_name": "MEDDERS",
            "middle_name": "DIANA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Victoria M Caudill, NP
• Kathryn Ann Caulfield, MD
• Walter Harry Caulfield III, MD
• Bailey Janean Cavanaugh, PA
• Jackson Tobin Cavanaugh, DPT
• Austin Cehelsky, PHARMD
• Teodor C Cenadic, DPT
• Center for Emotional Health
• Center for Vein Restoration NC PLLC
• Centerwell Pharmacy, Inc.

• Mental Health Counselor in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.