Healthcare Provider Details

I. General information

NPI: 1306001060
Provider Name (Legal Business Name): CAROLINAS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 E 7TH ST SUITE #206
CHARLOTTE NC
28204-2407
US

IV. Provider business mailing address

7895 FOXCROFT LN
CHARLOTTE NC
28213-3878
US

V. Phone/Fax

Practice location:
  • Phone: 704-351-6562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA CUPP
Title or Position: PRESIDENT
Credential:
Phone: 704-351-6562