Healthcare Provider Details

I. General information

NPI: 1326342320
Provider Name (Legal Business Name): CAROLINAS HOME CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S CANAL ST
WHITEVILLE NC
28472-4256
US

IV. Provider business mailing address

603 S CANAL ST
WHITEVILLE NC
28472-4256
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-3700
  • Fax: 910-642-5146
Mailing address:
  • Phone: 910-642-3700
  • Fax: 910-642-5146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MELODY CAMPBELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-642-3700