MEDICARE: CAROLINA COMMUNICATION CONSULTANTS, LLC

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	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578634945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA COMMUNICATION CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	8511 DAVIS LAKE PKWY
Second Line	:	SUITE C6-175
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0536
Country	:	US
Telephone Number	:	704-264-9296
Fax Number	:

Provider Business Practice Location Address
First Line	:	8511 DAVIS LAKE PKWY
Second Line	:	SUITE C6-175
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0536
Country	:	US
Telephone Number	:	704-264-9296
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. STACEY CHANTIA ROBINSON
Credential	:	CCC SLP
Telephone Number	:	704-264-9296

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	08/22/2020

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Directions to “CAROLINA COMMUNICATION CONSULTANTS, LLC ” Practice Location

Language	Start Address	Practice Location

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