Provider Demographics
NPI:1033505938
Name:CAROLINA CONCIERGE THERAPEUTICS, PLLC
Entity Type:Organization
Organization Name:CAROLINA CONCIERGE THERAPEUTICS, PLLC
Other - Org Name:CAROLINA THERAPEUTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR, SLP
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:HINNANT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, CAS
Authorized Official - Phone:704-654-8599
Mailing Address - Street 1:PO BOX 38118
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11201 LIVINGSTON MILL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4720
Practice Address - Country:US
Practice Address - Phone:704-654-8599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F228OtherMEDICARE