MEDICARE: CAROLINA BEHAVIORAL CARE, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1326764929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA BEHAVIORAL CARE, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1630
Second Line	:
City	:	PINEHURST
State	:	NC
Zip	:	28370-1630
Country	:	US
Telephone Number	:	910-295-6007
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 CARMEL EXECUTIVE PARK DR STE 155
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-8242
Country	:	US
Telephone Number	:	844-534-7208
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	KIM WISE
Credential	:
Telephone Number	:	910-295-8402

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	10/14/2022

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