Provider Demographics
NPI:1013184738
Name:CARRIGAN & ASSOCIATES COUNSELING, INC.
Entity Type:Organization
Organization Name:CARRIGAN & ASSOCIATES COUNSELING, INC.
Other - Org Name:MAIN ST. STATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:CARRIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:QP
Authorized Official - Phone:336-903-8500
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-0201
Mailing Address - Country:US
Mailing Address - Phone:336-903-8500
Mailing Address - Fax:336-903-8505
Practice Address - Street 1:403 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2505
Practice Address - Country:US
Practice Address - Phone:336-903-8500
Practice Address - Fax:336-903-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL097052261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300830Medicaid