Provider Demographics
NPI:1013211242
Name:CAROLINA FAMILY COMPREHENSIVE SERVICES, INC.
Entity Type:Organization
Organization Name:CAROLINA FAMILY COMPREHENSIVE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:704-548-9600
Mailing Address - Street 1:1935 JN PEASE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4541
Mailing Address - Country:US
Mailing Address - Phone:704-548-9600
Mailing Address - Fax:704-548-9666
Practice Address - Street 1:1935 JN PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4541
Practice Address - Country:US
Practice Address - Phone:704-548-9600
Practice Address - Fax:704-548-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health