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General NPI Number Information
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NPI Number | 1851877294
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Entity Type | Individual
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Provider Name | JORGE CARABALLO II LCMHC
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Gender | Male
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 1931 J N PEASE PL STE 201
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City | CHARLOTTE
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State | NC
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Zip | 28262-4543
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Country | US
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Telephone | 704-885-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 DANZANTE PL
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-9365
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Country | US
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Telephone | 910-229-7248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A14060
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License Number State | NC
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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 | 14060
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License Number State | NC
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