Provider Demographics
NPI:1598242117
Name:CAROLINA HUMAN SERVICES LLC
Entity Type:Organization
Organization Name:CAROLINA HUMAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-354-9406
Mailing Address - Street 1:408 BACON ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-5025
Mailing Address - Country:US
Mailing Address - Phone:336-354-9406
Mailing Address - Fax:
Practice Address - Street 1:6992 WAXHAW HWY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-7731
Practice Address - Country:US
Practice Address - Phone:336-354-9406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health