Provider Demographics
NPI:1457665028
Name:CAROLINA WELLTH
Entity Type:Organization
Organization Name:CAROLINA WELLTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-926-8320
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NC
Mailing Address - Zip Code:28760-0066
Mailing Address - Country:US
Mailing Address - Phone:828-693-3296
Mailing Address - Fax:
Practice Address - Street 1:600 BEVERLY HANKS CTR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2305
Practice Address - Country:US
Practice Address - Phone:828-693-3296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0010261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty