Provider Demographics
NPI:1346734712
Name:CONNOR, CAROLINE NICOLE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:NICOLE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 DOGWOOD LANDING RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT
Mailing Address - State:NC
Mailing Address - Zip Code:28556-9592
Mailing Address - Country:US
Mailing Address - Phone:252-670-2073
Mailing Address - Fax:
Practice Address - Street 1:175 DOGWOOD LANDING RD
Practice Address - Street 2:
Practice Address - City:MERRITT
Practice Address - State:NC
Practice Address - Zip Code:28556-9592
Practice Address - Country:US
Practice Address - Phone:252-670-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
NCC0134961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)