Provider Demographics
NPI:1558335679
Name:CAROLINAS COUNSELING GROUP OF CHARLOTTE, INC.
Entity Type:Organization
Organization Name:CAROLINAS COUNSELING GROUP OF CHARLOTTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-752-8414
Mailing Address - Street 1:7401 CARMEL EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8275
Mailing Address - Country:US
Mailing Address - Phone:704-752-8414
Mailing Address - Fax:704-752-8104
Practice Address - Street 1:7401 CARMEL EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8275
Practice Address - Country:US
Practice Address - Phone:704-752-8414
Practice Address - Fax:704-752-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2886101YP2500X
NC2266103T00000X
NC994106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty