Basic Information
| Provider Information | |||||||||
| NPI: | 1841896131 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA COUNSELING AND THERAPEUTIC SOLUTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | CAROLINA COUNSELING AND THERAPEUTIC SOLUTIONS | ||||||||
| Address2: | 12740 SPRUCE TREE WAY STE 102 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199161160 | ||||||||
| FaxNumber: | 9194884226 | ||||||||
| Practice Location | |||||||||
| Address1: | 12740 SPRUCE TREE WAY # 10212740 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276148295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199161160 | ||||||||
| FaxNumber: | 9194884226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2020 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | SHERYL | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9195229314 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCMHC, LCAS-A | ||||||||
| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.