Basic Information
| Provider Information | |||||||||
| NPI: | 1083221758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COTTON | ||||||||
| FirstName: | LYRICIST | ||||||||
| MiddleName: | DIOR | ||||||||
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| Credential: | LCMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 E 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280524358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048741904 | ||||||||
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| Practice Location | |||||||||
| Address1: | 915 TATE BLVD SE | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283450800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2020 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | A16298 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.