Healthcare Provider Details

I. General information

NPI: 1215237516
Provider Name (Legal Business Name): CAROLINA'S CREATIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 MONROE ROAD, SUITE 100
CHARLOTTE NC
28205
US

IV. Provider business mailing address

4415 MONROE ROAD, SUITE 100
CHARLOTTE NC
28205
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-3634
  • Fax: 704-332-1801
Mailing address:
  • Phone: 704-332-3634
  • Fax: 704-332-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHL-060-1269
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMHL-060-1269
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-060-1269
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-060-1269
License Number StateNC

VIII. Authorized Official

Name: CATHLEEN R HARRIS
Title or Position: OWNER & CEO
Credential: LCSW
Phone: 704-332-3634