Healthcare Provider Details

I. General information

NPI: 1689974982
Provider Name (Legal Business Name): CAROLINA'S CREATIVE COUNSELING, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MULBERRY STREET
LENOIR NC
28645-5725
US

IV. Provider business mailing address

325 MATTHEWS MINT HILL RD SUITE 104
MATTHEWS NC
28105-2889
US

V. Phone/Fax

Practice location:
  • Phone: 828-758-5101
  • Fax: 828-758-5191
Mailing address:
  • Phone: 704-844-0310
  • Fax: 704-844-0311

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 Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CATHY HARRIS
Title or Position: OWNER
Credential: LCSW
Phone: 704-844-0310