Provider Demographics
NPI:1851795710
Name:CAROLINA SUPPORT SERVICES, INC
Entity Type:Organization
Organization Name:CAROLINA SUPPORT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER.CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEPHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SPRUILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-347-4144
Mailing Address - Street 1:3783 PRESIDENTIAL PKWY
Mailing Address - Street 2:SUITE 127
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-3709
Mailing Address - Country:US
Mailing Address - Phone:252-347-4144
Mailing Address - Fax:
Practice Address - Street 1:3783 PRESIDENTIAL PKWY
Practice Address - Street 2:SUITE 127
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-3709
Practice Address - Country:US
Practice Address - Phone:252-347-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health