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
1	101YM0800X	Mental Health Counselor
2	261Q00000X	Clinic/Center
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1831837004
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	:	704-396-7524

Provider Business Practice Location Address
First Line	:	9505 REISTERSTOWN RD
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4451
Country	:	US
Telephone Number	:	704-864-1477
Fax Number	:	704-396-7524

Authorized Official
Title or Position	:	CEO
Name	:	CLARENCE SUTTON
Credential	:
Telephone Number	:	704-864-1477

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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