Provider Demographics
NPI:1063893568
Name:COTSWOLD CLINICIAN SUPPORT SERVICES
Entity type:Organization
Organization Name:COTSWOLD CLINICIAN SUPPORT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-493-4934
Mailing Address - Street 1:447 S SHARON AMITY RD
Mailing Address - Street 2:STE 250
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2889
Mailing Address - Country:US
Mailing Address - Phone:704-264-2973
Mailing Address - Fax:980-498-6700
Practice Address - Street 1:447 S SHARON AMITY RD
Practice Address - Street 2:STE 250
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2889
Practice Address - Country:US
Practice Address - Phone:704-264-2973
Practice Address - Fax:980-498-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty