Healthcare Provider Details

I. General information

NPI: 1265568240
Provider Name (Legal Business Name): CAROLINA CHOICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W ELIZABETH ST
CLINTON NC
28328-4021
US

IV. Provider business mailing address

PO BOX 12189
NEW BERN NC
28561-2189
US

V. Phone/Fax

Practice location:
  • Phone: 910-590-2616
  • Fax: 910-590-2622
Mailing address:
  • Phone: 252-633-3855
  • Fax: 252-633-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA SIMON
Title or Position: BILLING OFFICER
Credential:
Phone: 252-633-3855