Healthcare Provider Details

I. General information

NPI: 1679635387
Provider Name (Legal Business Name): CAROLINA DEVELOPMENTAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 AVON ST
MONROE NC
28110-3014
US

IV. Provider business mailing address

PO BOX 1047
MONROE NC
28111-1047
US

V. Phone/Fax

Practice location:
  • Phone: 704-218-6230
  • Fax: 704-973-0844
Mailing address:
  • Phone: 704-218-6230
  • Fax: 704-973-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JANICE ELAINE HELMS
Title or Position: PROGRAM DIRECTOR
Credential: LPC, ITFS
Phone: 704-218-6230