Healthcare Provider Details

I. General information

NPI: 1104377357
Provider Name (Legal Business Name): CARENET, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 E 14TH ST
WINSTON SALEM NC
27105-6804
US

IV. Provider business mailing address

PO BOX 1097
WINSTON SALEM NC
27157-1097
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-0800
  • Fax: 336-716-0822
Mailing address:
  • Phone: 336-716-0800
  • Fax: 336-716-0822

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: ROBERT A WILLIS
Title or Position: PRESIDENT
Credential: LMFT
Phone: 336-716-0858