MEDICARE: CHARLIES ANGELS COMMUNITY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225C00000X	Rehabilitation Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM0850X	Adult Mental Health Clinic/Center
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1881466357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLIES ANGELS COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	1214 BOTTLE BRUSH LN
Second Line	:
City	:	HARRISBURG
State	:	NC
Zip	:	28075-6715
Country	:	US
Telephone Number	:	412-977-1273
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 HIGHWAY 90 E
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-9261
Country	:	US
Telephone Number	:	704-918-7966
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CARLITA RANDALL
Credential	:
Telephone Number	:	412-977-1273

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	04/15/2025

Similar Medicare Providers

1376688796 — MR. JEFFREY DWAYNE RANDALL MPC
Practice Location Address:

501 HIGHWAY 90 E
LITTLE RIVER, SC
29566-9261

Practice Phone: 803-422-7231
Practice Fax:

1386642924 — DR. DANIEL RAYMOND FARRELL M.D.
Practice Location Address:

12014 W BAYSHORE DR
CRYSTAL RIVER, FL
34429-9261

Practice Phone: 407-620-0211
Practice Fax: 352-220-6463

1760666283 — DR. ALLEN IRA SOBEL O.D.
Practice Location Address:

12034 W BAYSHORE DR
CRYSTAL RIVER, FL
34429-9261

Practice Phone: 352-794-0091
Practice Fax:

1134865884 — LAURIE KUSHEL PARKER LMFT
Practice Location Address:

9261 N NEW RIVER CANAL RD
PLANTATION, FL
33324-3807

Practice Phone: 954-816-7090
Practice Fax:

1629751185 — ALEXIS MCKENZIE SUTHERLAND APRN, FNP-C
Practice Location Address:

4000 HIGHWAY 9 E
LITTLE RIVER, SC
29566-7833

Practice Phone: 843-390-8304
Practice Fax:

1124974332 — AUDIOLOGY SERVICES COMPANY USA, LLC
Practice Location Address:

3702 SEA MOUNTAIN HWY STE B
LITTLE RIVER, SC
29566-7860

Practice Phone: 843-294-1900
Practice Fax:

Directions to “CHARLIES ANGELS COMMUNITY SERVICES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.