Healthcare Provider Details

I. General information

NPI: 1609370535
Provider Name (Legal Business Name): CAROLYN BYRNE RIFKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 ADAMS FARM PKWY
GREENSBORO NC
27407-6338
US

IV. Provider business mailing address

330 LAKESHORE DR
HILLSBOROUGH NC
27278-2229
US

V. Phone/Fax

Practice location:
  • Phone: 336-772-7266
  • Fax:
Mailing address:
  • Phone: 203-824-2385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22296
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA11948
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11948
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: