Healthcare Provider Details

I. General information

NPI: 1821562224
Provider Name (Legal Business Name): CARTER CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 W 3RD AVE BLDG A
RED SPRINGS NC
28377-1524
US

IV. Provider business mailing address

PO BOX 99778
RALEIGH NC
27624-9778
US

V. Phone/Fax

Practice location:
  • Phone: 910-491-2352
  • Fax: 910-491-2383
Mailing address:
  • Phone: 919-848-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MYLEME OJINA HARRISON
Title or Position: CEO
Credential:
Phone: 919-848-0132