MEDICARE: CAROLINA OUTREACH, 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	1041C0700X	Clinical Social Worker
2	251S00000X	Community/Behavioral Health Agency

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

General Provider Information

NPI Number	:	1710687967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA OUTREACH, LLC

Provider Business Mailing Address
First Line	:	2670 DURHAM CHAPEL HILL BLVD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2829
Country	:	US
Telephone Number	:	720-402-2296
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 APRIL LIU LN APT 311
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-6966
Country	:	US
Telephone Number	:	704-332-8787
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JAMES MITCHELL VEDDER
Credential	:
Telephone Number	:	703-844-1007

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/07/2023

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Directions to “CAROLINA OUTREACH, LLC ” Practice Location

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