Provider Demographics
NPI:1114156163
Name:CAROLINA'S CREATIVE COUNSELING, PA
Entity Type:Organization
Organization Name:CAROLINA'S CREATIVE COUNSELING, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-438-3349
Mailing Address - Street 1:4415 MONROE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7743
Mailing Address - Country:US
Mailing Address - Phone:704-332-3634
Mailing Address - Fax:704-332-1801
Practice Address - Street 1:4415 MONROE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7743
Practice Address - Country:US
Practice Address - Phone:704-332-3634
Practice Address - Fax:704-332-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00104542Medicaid