Healthcare Provider Details

I. General information

NPI: 1033557665
Provider Name (Legal Business Name): CAROLINA BEACH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 LAKE PARK BLVD N SUITE 109
CAROLINA BEACH NC
28428
US

IV. Provider business mailing address

1328 LAKE PARK BLVD N SUITE 109
CAROLINA BEACH NC
28428-3935
US

V. Phone/Fax

Practice location:
  • Phone: 910-458-4544
  • Fax: 910-458-4824
Mailing address:
  • Phone: 910-458-4544
  • Fax: 910-458-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: COREY ANDOLFI
Title or Position: OWNER
Credential:
Phone: 910-458-4544