Healthcare Provider Details

I. General information

NPI: 1760760003
Provider Name (Legal Business Name): CAROLINA'S CREATIVE COUNSELING, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MATTHEWS MINT HILL RD SUITE 104
MATTHEWS NC
28015-2889
US

IV. Provider business mailing address

325 MATTHEWS MINT HILL ROAD SUITE 105
MATTHEWS NC
28105-2889
US

V. Phone/Fax

Practice location:
  • Phone: 704-844-0310
  • Fax: 704-844-0311
Mailing address:
  • Phone: 704-844-0310
  • Fax: 704-844-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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