Healthcare Provider Details

I. General information

NPI: 1346698180
Provider Name (Legal Business Name): CAROLINA SOLUTION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 EBENEZER RD SUITE I
ROCK HILL SC
29732-1062
US

IV. Provider business mailing address

PO BOX 1293
RAEFORD NC
28376-1293
US

V. Phone/Fax

Practice location:
  • Phone: 803-992-0499
  • Fax: 803-620-1543
Mailing address:
  • Phone: 910-550-3803
  • Fax: 407-479-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BENNY LOCKLEAR
Title or Position: CEO
Credential:
Phone: 910-550-3803