Provider Demographics
NPI:1508992074
Name:CAROLINA COMPREHENSIVE SERVICES, LLC
Entity Type:Organization
Organization Name:CAROLINA COMPREHENSIVE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONDAH
Authorized Official - Middle Name:TIANGAI
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-507-7674
Mailing Address - Street 1:312 W MILLBROOK RD
Mailing Address - Street 2:SUITE 137
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4389
Mailing Address - Country:US
Mailing Address - Phone:919-847-0550
Mailing Address - Fax:919-847-0599
Practice Address - Street 1:312 W MILLBROOK RD
Practice Address - Street 2:SUITE 137
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4389
Practice Address - Country:US
Practice Address - Phone:919-847-0550
Practice Address - Fax:919-847-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301511Medicaid
NC8301571Medicaid