1760760003 NPI number — CAROLINA'S CREATIVE COUNSELING, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760760003 NPI number — CAROLINA'S CREATIVE COUNSELING, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA'S CREATIVE COUNSELING, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760760003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 MATTHEWS MINT HILL ROAD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28105-2889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-844-0310
Provider Business Mailing Address Fax Number:
704-844-0311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 MATTHEWS MINT HILL RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28015-2889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-844-0310
Provider Business Practice Location Address Fax Number:
704-844-0311
Provider Enumeration Date:
08/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-844-0310

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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