Provider Demographics
NPI:1437214715
Name:CARRIGAN & ASSOCIATES COUNSELING INC
Entity Type:Organization
Organization Name:CARRIGAN & ASSOCIATES COUNSELING INC
Other - Org Name:MAIN STREET STATION PSYCHO SOCIAL REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CORPORATE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:CARRIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:QUALIFED MENTAL HEAL
Authorized Official - Phone:336-903-8500
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697
Mailing Address - Country:US
Mailing Address - Phone:336-903-8500
Mailing Address - Fax:336-903-8505
Practice Address - Street 1:403 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697
Practice Address - Country:US
Practice Address - Phone:336-903-8500
Practice Address - Fax:336-903-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL097052261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300830SMedicaid