MEDICARE: CARTERET COUNSELING SERVICES, INC.

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	101Y00000X	Counselor	MHL-016-034	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	MHL-016-034	NC
3	101YP2500X	Professional Counselor	MHL-016-034	NC
4	251S00000X	Community/Behavioral Health Agency	MHL-016-034	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MHL 016-034	OTHER	NC	MH/DD/SAS

General Provider Information

NPI Number	:	1407913742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTERET COUNSELING SERVICES, INC.

Provider Business Mailing Address
First Line	:	105 N 10TH ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3806
Country	:	US
Telephone Number	:	252-247-1109
Fax Number	:	252-247-1107

Provider Business Practice Location Address
First Line	:	3820 BRIDGES ST
Second Line	:	STE B
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2979
Country	:	US
Telephone Number	:	252-247-1109
Fax Number	:	252-247-1107

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONALD MRDJENOVIC III
Credential	:	CCS, CSAC
Telephone Number	:	252-247-1109

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	10/02/2018

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