Provider Demographics
NPI:1689974982
Name:CAROLINA'S CREATIVE COUNSELING, PA
Entity Type:Organization
Organization Name:CAROLINA'S CREATIVE COUNSELING, PA
Other - Org Name:CAROLINA'S CREATIVE COUNSELING, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-844-0310
Mailing Address - Street 1:325 MATTHEWS MINT HILL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2889
Mailing Address - Country:US
Mailing Address - Phone:704-844-0310
Mailing Address - Fax:704-844-0311
Practice Address - Street 1:520 MULBERRY STREET
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5725
Practice Address - Country:US
Practice Address - Phone:828-758-5101
Practice Address - Fax:828-758-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty