Provider Demographics
NPI:1124223631
Name:CARTER BEHAVIOR HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CARTER BEHAVIOR HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR, P-LCAS
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:SPELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-347-3950
Mailing Address - Street 1:308 GREENVILLE BLVD SE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5758
Mailing Address - Country:US
Mailing Address - Phone:252-353-5577
Mailing Address - Fax:252-353-8577
Practice Address - Street 1:501A GREENVILLE BLVD SE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6736
Practice Address - Country:US
Practice Address - Phone:252-353-5577
Practice Address - Fax:252-353-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 2084P0804X, 251S00000X
NCHC4036251E00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418973Medicaid
NC6601979Medicaid
NC8302032Medicaid
NC5909095Medicaid
NC6006375Medicaid