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General NPI Number Information
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NPI Number | 1134987100
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Entity Type | Organization
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Legal Business Name | CAROLINA'S MEDICAL & WELLNESS CLINIC
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 821A S MAIN ST
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City | LAURINBURG
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State | NC
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Zip | 28352-4724
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Country | US
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Telephone | 910-506-8474
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Fax | 855-736-1881
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Provider Business Mailing Address
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Address Line | 821A S MAIN ST
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City | LAURINBURG
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State | NC
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Zip | 28352-4724
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Country | US
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Telephone | 910-506-8474
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Fax | 855-736-1881
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER COUGHENOUR
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Credential | FNP
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Telephone | 910-506-8474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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