Provider Demographics
NPI:1043672793
Name:CAROLINA SEXUAL WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:CAROLINA SEXUAL WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:NABAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:919-297-8322
Mailing Address - Street 1:102 COMMONWEALTH CT
Mailing Address - Street 2:STE. H
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4400
Mailing Address - Country:US
Mailing Address - Phone:919-297-8322
Mailing Address - Fax:
Practice Address - Street 1:102 COMMONWEALTH CT
Practice Address - Street 2:STE. H
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4400
Practice Address - Country:US
Practice Address - Phone:919-297-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4785261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)