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General NPI Number Information
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NPI Number | 1790003481
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Entity Type | Organization
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Legal Business Name | CAROLINA FAMILY COMPREHENSIVE SERVICES, INC.
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 1935 JN PEASE PLACE SUITE 104
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City | CHARLOTTE
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State | NC
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Zip | 28262-4554
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Country | US
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Telephone | 704-548-9600
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Fax | 704-548-9666
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Provider Business Mailing Address
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Address Line | 1935 JN PEASE PLACE SUITE 104
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City | CHARLOTTE
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State | NC
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Zip | 28262-4554
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Country | US
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Telephone | 704-548-9600
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Fax | 704-548-9666
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIM CRUMP
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Credential |
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Telephone | 704-548-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | NC
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Taxonomy #2
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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 | NC
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Taxonomy #3
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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 | NC
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | NC
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Taxonomy #6
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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 | NC
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Taxonomy #7
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NC
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Taxonomy #8
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | NC
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Taxonomy #9
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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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