Provider Demographics
NPI:1033557665
Name:CAROLINA BEACH COUNSELING, LLC
Entity Type:Organization
Organization Name:CAROLINA BEACH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDOLFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-458-4544
Mailing Address - Street 1:1328 LAKE PARK BLVD N
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-3935
Mailing Address - Country:US
Mailing Address - Phone:910-458-4544
Mailing Address - Fax:910-458-4824
Practice Address - Street 1:1328 LAKE PARK BLVD N
Practice Address - Street 2:SUITE 109
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428
Practice Address - Country:US
Practice Address - Phone:910-458-4544
Practice Address - Fax:910-458-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty