Provider Demographics
NPI:1376575266
Name:CENTRAL CAROLINA CENTERS FOR COUNSELING & PSYCHOLOGICAL SERVICE
Entity Type:Organization
Organization Name:CENTRAL CAROLINA CENTERS FOR COUNSELING & PSYCHOLOGICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-772-9371
Mailing Address - Street 1:223 HWY 70 E
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4062
Mailing Address - Country:US
Mailing Address - Phone:919-772-9371
Mailing Address - Fax:919-779-6999
Practice Address - Street 1:223 HWY 70 EAST
Practice Address - Street 2:SUITE 130
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-772-9371
Practice Address - Fax:919-779-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1116103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2815183Medicare ID - Type Unspecified
NC6000510Medicaid