Healthcare Provider Details

I. General information

NPI: 1912069303
Provider Name (Legal Business Name): CAROLINA CENTER FOR AUTISM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SANCAR WAY STE 410
DURHAM NC
27713-2891
US

IV. Provider business mailing address

4000 SANCAR WAY STE 410
DURHAM NC
27713-2891
US

V. Phone/Fax

Practice location:
  • Phone: 919-371-2848
  • Fax: 919-467-6777
Mailing address:
  • Phone: 919-371-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: XICOTENCAL BRANDON GARCILAZO
Title or Position: PRESIDENT & CFO
Credential:
Phone: 305-440-7029