Provider Demographics
NPI:1639616782
Name:CAROLINA COUNSELING AND CONSULTING SERVICES, PLLC
Entity Type:Organization
Organization Name:CAROLINA COUNSELING AND CONSULTING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-266-4208
Mailing Address - Street 1:531 BRENTWOOD ROAD
Mailing Address - Street 2:# 308
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0269
Mailing Address - Country:US
Mailing Address - Phone:704-266-4208
Mailing Address - Fax:866-876-6809
Practice Address - Street 1:10105 HICKORYWOOD HILL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-266-4208
Practice Address - Fax:866-876-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty