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NPI Code Detail

MEDICARE: CAROLINA PSYCHOLOGICAL AND PSYCHIATRIC HEALTH SRVS, PA

MEDICARE: CAROLINA PSYCHOLOGICAL AND PSYCHIATRIC HEALTH SRVS, PA
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
11041C0700XClinical Social Worker
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
32084P0800XPsychiatry Physician
4363LP0808XPsychiatric/Mental Health Nurse Practitioner
5101YP2500XProfessional Counselor
6103T00000XPsychologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10296JOTHERNCBC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770561193
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROLINA PSYCHOLOGICAL AND PSYCHIATRIC HEALTH SRVS, PA
Provider Business Mailing Address
First Line : 1703 COUNTRY CLUB RD STE 204
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-6006
Country : US
Telephone Number : 910-347-3010
Fax Number : 910-347-3201
Provider Business Practice Location Address
First Line : 1703 COUNTRY CLUB RD STE 204
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-6098
Country : US
Telephone Number : 910-347-3010
Fax Number : 910-347-6137
Authorized Official
Title or Position : CEO
Name : ALBERT LUPIN
Credential :
Telephone Number : 704-247-6896
Provider Enumeration Date : 01/05/2006
Last Update Date : 03/24/2026

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