Provider Demographics
NPI:1578634945
Name:CAROLINA COMMUNICATION CONSULTANTS, LLC
Entity Type:Organization
Organization Name:CAROLINA COMMUNICATION CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:CHANTIA
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC SLP
Authorized Official - Phone:704-264-9296
Mailing Address - Street 1:8511 DAVIS LAKE PKWY
Mailing Address - Street 2:SUITE C6-175
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0536
Mailing Address - Country:US
Mailing Address - Phone:704-264-9296
Mailing Address - Fax:
Practice Address - Street 1:8511 DAVIS LAKE PKWY
Practice Address - Street 2:SUITE C6-175
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0536
Practice Address - Country:US
Practice Address - Phone:704-264-9296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212099Medicaid