Healthcare Provider Details

I. General information

NPI: 1831837004
Provider Name (Legal Business Name): CAROLINA THERAPEUTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 REISTERSTOWN RD
OWINGS MILLS MD
21117-4451
US

IV. Provider business mailing address

1528 UNION RD
GASTONIA NC
28054-2200
US

V. Phone/Fax

Practice location:
  • Phone: 704-864-1477
  • Fax: 704-396-7524
Mailing address:
  • Phone: 704-864-1477
  • Fax: 704-396-7524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CLARENCE SUTTON
Title or Position: CEO
Credential:
Phone: 704-864-1477