Provider Demographics
NPI:1700039104
Name:CAROLINA CHOICE LLC
Entity Type:Organization
Organization Name:CAROLINA CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-633-3855
Mailing Address - Street 1:PO BOX 12189
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2189
Mailing Address - Country:US
Mailing Address - Phone:252-633-3855
Mailing Address - Fax:252-633-1548
Practice Address - Street 1:5353 RED TIP RD
Practice Address - Street 2:SUITE 111 & 112
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0255
Practice Address - Country:US
Practice Address - Phone:910-485-0330
Practice Address - Fax:910-482-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty