Basic Information
| Provider Information | |||||||||
| NPI: | 1346698180 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA SOLUTION INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1293 | ||||||||
| Address2: | |||||||||
| City: | RAEFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283761293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105503803 | ||||||||
| FaxNumber: | 4074793846 | ||||||||
| Practice Location | |||||||||
| Address1: | 2025 EBENEZER RD | ||||||||
| Address2: | SUITE I | ||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297321062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039920499 | ||||||||
| FaxNumber: | 8036201543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2016 | ||||||||
| LastUpdateDate: | 06/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | LOCKLEAR | ||||||||
| AuthorizedOfficialFirstName: | BENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9105503803 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | CM1066 | 05 | SC | MEDICAID |