Healthcare Provider Details

I. General information

NPI: 1669790051
Provider Name (Legal Business Name): CAROLINA ACCESS SUPPORT AND ENRICHMENT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 REAGAN DR STE 10
CHARLOTTE NC
28206-1395
US

IV. Provider business mailing address

5108 REAGAN DR STE 10
CHARLOTTE NC
28206-1395
US

V. Phone/Fax

Practice location:
  • Phone: 704-200-9949
  • Fax: 704-353-7233
Mailing address:
  • Phone: 704-200-9949
  • Fax: 704-353-7233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MS. FELICIA E CAMPBELL
Title or Position: CEO
Credential: MBA, QP
Phone: 704-200-9949