Provider Demographics
NPI:1679150015
Name:ROCK OF REFUGE
Entity type:Organization
Organization Name:ROCK OF REFUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:VASILAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NCC, LCMHCS
Authorized Official - Phone:704-709-1147
Mailing Address - Street 1:1963 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9570
Mailing Address - Country:US
Mailing Address - Phone:704-709-1147
Mailing Address - Fax:980-495-8940
Practice Address - Street 1:2922 AUDREY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7268
Practice Address - Country:US
Practice Address - Phone:704-709-1147
Practice Address - Fax:980-495-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty