Healthcare Provider Details

I. General information

NPI: 1720262678
Provider Name (Legal Business Name): CAROLINAS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 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: 704-455-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3106
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRENDA CUPP
Title or Position: PRESIDENT
Credential:
Phone: 704-455-6433