Healthcare Provider Details

I. General information

NPI: 1609833490
Provider Name (Legal Business Name): CARTERET CLINIC FOR ADOLESCENTS AND CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 JOHN PLATT DR
MOREHEAD CITY NC
28557-4321
US

IV. Provider business mailing address

3510 JOHN PLATT DR
MOREHEAD CITY NC
28557-4321
US

V. Phone/Fax

Practice location:
  • Phone: 252-726-0511
  • Fax: 252-726-7441
Mailing address:
  • Phone: 252-726-0511
  • Fax: 252-726-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4461
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1501
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16287
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200700362
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9800605
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201519
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200683
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number300102
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number005003504
License Number StateNC
# 10
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5006954
License Number StateNC

VIII. Authorized Official

Name: LAURIE PARTUSCH-WHITT
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 252-726-0511