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General NPI Number Information
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NPI Number | 1740463439
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Entity Type | Organization
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Legal Business Name | CAROLINA'S THERAPY SOLUTIONS
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 1009 WICKERBY CT
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-3738
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Country | US
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Telephone | 704-608-0445
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 634
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-0634
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Country | US
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Telephone | 704-608-0445
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JON WAYNE ECCLESTON II
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Credential | LCSW
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Telephone | 704-608-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NC
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