Provider Demographics
NPI:1174045710
Name:CAROLINA BEHAVIORAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:CAROLINA BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERESA
Authorized Official - Middle Name:BLACKMON
Authorized Official - Last Name:CATOE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:803-283-7465
Mailing Address - Street 1:505 WOODLAND DRIVE
Mailing Address - Street 2:PO BOX 548
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-0548
Mailing Address - Country:US
Mailing Address - Phone:803-283-7465
Mailing Address - Fax:
Practice Address - Street 1:505 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1704
Practice Address - Country:US
Practice Address - Phone:803-283-7465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18183363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty