Provider Demographics
NPI:1679635387
Name:CAROLINA DEVELOPMENTAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CAROLINA DEVELOPMENTAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ITFS
Authorized Official - Phone:704-218-6230
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-1047
Mailing Address - Country:US
Mailing Address - Phone:704-218-6230
Mailing Address - Fax:704-973-0844
Practice Address - Street 1:104 AVON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3014
Practice Address - Country:US
Practice Address - Phone:704-218-6230
Practice Address - Fax:704-973-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301732Medicaid