Provider Demographics
NPI:1609994979
Name:CAROLINA BEHAVIORAL HEALTH SERVICES,PLLC
Entity Type:Organization
Organization Name:CAROLINA BEHAVIORAL HEALTH SERVICES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:UKAOMA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, PSYD, ICCD-P,
Authorized Official - Phone:704-712-7669
Mailing Address - Street 1:1101 TYVOLA RD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3515
Mailing Address - Country:US
Mailing Address - Phone:704-712-7669
Mailing Address - Fax:704-264-3031
Practice Address - Street 1:1101 TYVOLA RD
Practice Address - Street 2:SUITE 304
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3515
Practice Address - Country:US
Practice Address - Phone:704-712-7669
Practice Address - Fax:704-264-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4813251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005825Medicaid
NC6102192Medicaid