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General NPI Number Information
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NPI Number | 1710701149
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Entity Type | Organization
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Legal Business Name | CAROLINA OUTPATIENT DETOX, LLC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1117 E MOREHEAD ST
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City | CHARLOTTE
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State | NC
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Zip | 28204-2895
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Country | US
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Telephone | 859-304-4047
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Fax |
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Provider Business Mailing Address
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Address Line | 1117 E MOREHEAD ST STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28204-2870
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SHANNON ERB
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Credential |
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Telephone | 859-304-4047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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