Provider Demographics
NPI:1245412220
Name:CAROLINA ACCESS LIFE LINE, LLC
Entity Type:Organization
Organization Name:CAROLINA ACCESS LIFE LINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-480-5957
Mailing Address - Street 1:2898 A WILLOW COVE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1636
Mailing Address - Country:US
Mailing Address - Phone:336-480-5957
Mailing Address - Fax:336-854-4452
Practice Address - Street 1:2898 A WILLOW COVE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1636
Practice Address - Country:US
Practice Address - Phone:336-480-5957
Practice Address - Fax:336-854-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health