Basic Information
| Provider Information | |||||||||
| NPI: | 1265515969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEVELAND COUNTY SCHOOLS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 E RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | KINGS MOUNTAIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280863034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044768000 | ||||||||
| FaxNumber: | 7044768304 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 E RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | KINGS MOUNTAIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280863034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044768000 | ||||||||
| FaxNumber: | 7044768304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | PUTNAM | ||||||||
| AuthorizedOfficialFirstName: | TERI | ||||||||
| AuthorizedOfficialMiddleName: | HALL | ||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIOR LIAISON | ||||||||
| AuthorizedOfficialTelephone: | 7044723896 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MA,LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | Y | Agencies | Local Education Agency (LEA) |
ID Information
| ID | Type | State | Issuer | Description | 8600034 | 05 | NC | MEDICAID |