MEDICARE: CLARISSA CARR

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-20001	NC
2	101YP2500X	Professional Counselor	7924	NC
3	101YM0800X	Mental Health Counselor	7924	NC

General Provider Information

NPI Number	:	1497076855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARISSA CARR

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-2322
Fax Number	:	704-316-1682

Provider Business Practice Location Address
First Line	:	8820 RACHEL FREEMAN WAY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-9510
Country	:	US
Telephone Number	:	704-316-2322
Fax Number	:	704-316-1682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	06/11/2021

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Directions to “ CLARISSA CARR ” Practice Location

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