MEDICARE: CAROLINA CHOICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1346493749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CHOICE LLC

Provider Business Mailing Address
First Line	:	PO BOX 12189
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28561-2189
Country	:	US
Telephone Number	:	252-633-3855
Fax Number	:	252-633-1548

Provider Business Practice Location Address
First Line	:	114 N SPRUCE ST
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-0000
Country	:	US
Telephone Number	:	252-234-0200
Fax Number	:	252-234-7140

Authorized Official
Title or Position	:	BILLING OFFICER
Name	:	MS. DONNA SIMON
Credential	:
Telephone Number	:	252-633-3855

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	09/17/2010

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Directions to “CAROLINA CHOICE LLC ” Practice Location

Language	Start Address	Practice Location

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