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General NPI Number Information
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NPI Number | 1053642363
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Entity Type | Organization
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Legal Business Name | CAROLINAS PHYSICIANS NETWORK, INC.
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 5435 PROSPERITY CHURCH ROAD STE 2200
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City | CHARLOTTE
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State | NC
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Zip | 28269-2344
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Country | US
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Telephone | 704-863-9830
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Fax | 704-863-9831
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Provider Business Mailing Address
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Address Line | PO BOX 602120
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City | CHARLOTTE
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State | NC
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Zip | 28260-2120
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Country | US
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Telephone | 704-512-4808
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Fax | 704-512-4838
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. THOMAS FORD LAYMON
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Credential |
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Telephone | 704-446-8250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | NC
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