Basic Information
| Provider Information | |||||||||
| NPI: | 1184027252 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CAROLINA CENTER FOR ABA & AUTISM TREATMENT | ||||||||
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| OtherOrganizationName: | CREATIVE CONSULTANTS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 MACKENAN DR | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275117903 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 MACKENAN DR | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275117903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193712848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2014 | ||||||||
| LastUpdateDate: | 10/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | DECANDIA-FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9193712848 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.