MEDICARE: TRAUMA THERAPY OF THE CAROLINAS 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	101YM0800X	Mental Health Counselor	10758	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10758	OTHER	NC	NC BOARD OF LPC

General Provider Information

NPI Number	:	1942716808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA THERAPY OF THE CAROLINAS LLC

Provider Business Mailing Address
First Line	:	13717 CINNABAR PL
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5342
Country	:	US
Telephone Number	:	704-962-1924
Fax Number	:

Provider Business Practice Location Address
First Line	:	9723 NORTHCROSS CENTER CT STE L
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7301
Country	:	US
Telephone Number	:	704-962-1924
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IRIS ESTHER WHITLOCK
Credential	:	LPC
Telephone Number	:	704-962-1924

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	07/06/2024

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