Healthcare Provider Details

I. General information

NPI: 1821536699
Provider Name (Legal Business Name): CAROLINA COMMUNITY BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 W MEADOWVIEW RD STE 109
GREENSBORO NC
27407-3401
US

IV. Provider business mailing address

2216 W MEADOWVIEW RD STE 109
GREENSBORO NC
27407-3401
US

V. Phone/Fax

Practice location:
  • Phone: 704-994-2555
  • Fax:
Mailing address:
  • Phone: 704-994-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE CROSBY
Title or Position: OWNER
Credential:
Phone: 704-994-2555