Healthcare Provider Details

I. General information

NPI: 1154112274
Provider Name (Legal Business Name): CAROLINA HEALTH ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 GENTLE BEND WAY
FAYETTEVILLE NC
28314-6283
US

IV. Provider business mailing address

1817 GENTLE BEND WAY
FAYETTEVILLE NC
28314-6283
US

V. Phone/Fax

Practice location:
  • Phone: 910-224-5636
  • Fax: 910-224-5636
Mailing address:
  • Phone: 910-224-5636
  • Fax: 910-224-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE MACK
Title or Position: CEO
Credential: DNP FNP-C
Phone: 910-224-5636