Provider Demographics
NPI:1497871925
Name:LOFTUS, CAROL N (LCAS,CSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:N
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:LCAS,CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 IRVING PARK LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2473
Mailing Address - Country:US
Mailing Address - Phone:336-286-9962
Mailing Address - Fax:
Practice Address - Street 1:301 E WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2957
Practice Address - Country:US
Practice Address - Phone:336-333-6860
Practice Address - Fax:336-275-1187
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253101YA0400X
NCA000160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111807Medicaid