MEDICARE: CAROLINA CENTER FOR AUTISM SERVICES, 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	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1912069303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CENTER FOR AUTISM SERVICES, LLC

Provider Business Mailing Address
First Line	:	4000 SANCAR WAY STE 410
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-2891
Country	:	US
Telephone Number	:	919-371-2848
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 SANCAR WAY STE 410
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-2891
Country	:	US
Telephone Number	:	919-371-2848
Fax Number	:	919-467-6777

Authorized Official
Title or Position	:	PRESIDENT & CFO
Name	:	XICOTENCAL BRANDON GARCILAZO
Credential	:
Telephone Number	:	305-440-7029

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	11/04/2025

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