Provider Demographics
NPI:1760760003
Name:CAROLINA'S CREATIVE COUNSELING, PA
Entity Type:Organization
Organization Name:CAROLINA'S CREATIVE COUNSELING, PA
Other - Org Name:
Other - Org Type:
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 ROAD
Mailing Address - Street 2:SUITE 105
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 1:325 MATTHEWS MINT HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28015-2889
Practice Address - Country:US
Practice Address - Phone:704-844-0310
Practice Address - Fax:704-844-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health