MEDICARE: SUMMIT CAROLINAS CONSULTING 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

General Provider Information

NPI Number	:	1477447241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT CAROLINAS CONSULTING LLC

Provider Business Mailing Address
First Line	:	2820 SELWYN AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-1785
Country	:	US
Telephone Number	:	704-605-6286
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 SELWYN AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-1785
Country	:	US
Telephone Number	:	704-605-6286
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLYDE PHILLIP THOMAS
Credential	:
Telephone Number	:	704-605-6286

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	12/17/2025

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