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General NPI Number Information
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NPI Number | 1306653365
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Entity Type | Organization
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Legal Business Name | CAROLINA THERAPEUTIC SERVICES COMMUNITY DEVELOPMENT INC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 3015 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3342
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Country | US
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Telephone | 704-615-8669
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Fax |
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Provider Business Mailing Address
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Address Line | 1528 UNION RD
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City | GASTONIA
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State | NC
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Zip | 28054-2200
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Country | US
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Telephone | 704-864-1477
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Fax |
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Authorized Official
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Title or Position | EXEC DIRECTOR
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Name | ALVINA STREET
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Credential |
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Telephone | 704-615-8669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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