Healthcare Provider Details

I. General information

NPI: 1740479948
Provider Name (Legal Business Name): CAROLINA CHOICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 ARENDELL ST SUITE 1
MOREHEAD CITY NC
28557-2940
US

IV. Provider business mailing address

PO BOX 12189
NEW BERN NC
28561-2189
US

V. Phone/Fax

Practice location:
  • Phone: 252-240-1400
  • Fax: 252-240-1405
Mailing address:
  • Phone: 252-633-3855
  • Fax: 252-633-1548

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARSHA BUTLER
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 252-633-3855