Healthcare Provider Details

I. General information

NPI: 1477607786
Provider Name (Legal Business Name): CAROLINA BEHAVIORAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 CREEDMOOR RD STE 100
RALEIGH NC
27612-6333
US

IV. Provider business mailing address

PO BOX 1630
PINEHURST NC
28370-1630
US

V. Phone/Fax

Practice location:
  • Phone: 919-852-5352
  • Fax: 919-852-5323
Mailing address:
  • Phone: 910-295-6007
  • Fax: 910-215-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FLEURY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 910-295-6007