Provider Demographics
NPI:1376713776
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:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:THOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:336-408-5957
Mailing Address - Street 1:2900 REYNOLDS PARK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 REYNOLDS PARK RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1653
Practice Address - Country:US
Practice Address - Phone:336-408-5957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health