Provider Demographics
NPI:1417435710
Name:PORCELAIN DOLLS OF THE CAROLINAS, INC
Entity Type:Organization
Organization Name:PORCELAIN DOLLS OF THE CAROLINAS, INC
Other - Org Name:PORCELAIN DOLLS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-951-5987
Mailing Address - Street 1:13000 S TRYON ST # F-122
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7652
Mailing Address - Country:US
Mailing Address - Phone:704-951-5987
Mailing Address - Fax:980-219-8444
Practice Address - Street 1:5835 EXECUTIVE CENTER DR # 101-I
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212
Practice Address - Country:US
Practice Address - Phone:704-606-7824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of Service