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General NPI Number Information
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NPI Number | 1679125462
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Entity Type | Organization
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Legal Business Name | CARN 360 SERVICES LLC
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 09/21/2019
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Provider Practice Location Address
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Address Line | 1375 GATEWAY BLVD STE 29
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8304
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Country | US
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Telephone | 561-379-1440
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Fax | 561-471-3288
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Provider Business Mailing Address
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Address Line | 6586 HYPOLUXO RD STE 230
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City | LAKE WORTH
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State | FL
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Zip | 33467-7678
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Country | US
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Telephone | 561-248-8900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TERRENCE LENORRIS CARN SR.
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Credential | LCSW, MCAP
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Telephone | 561-248-8900
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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