MEDICARE: CAROLINA THERAPEUTIC 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	101YM0800X	Mental Health Counselor
3	103T00000X	Psychologist
4	103T00000X	Psychologist	3970	NC
5	253J00000X	Foster Care Agency	DSS-5146A	NC
6	253J00000X	Foster Care Agency
7	253Z00000X	In Home Supportive Care Agency
8	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
9	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1720247570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA THERAPEUTIC SERVICES, INC

Provider Business Mailing Address
First Line	:	1528 UNION RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2200
Country	:	US
Telephone Number	:	704-864-1477
Fax Number	:	704-864-1476

Provider Business Practice Location Address
First Line	:	1528 UNION RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054
Country	:	US
Telephone Number	:	704-864-1477
Fax Number	:	704-864-1476

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CLARENCE EDWARD SUTTON
Credential	:
Telephone Number	:	704-884-5552

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	02/01/2021

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