Provider Demographics
NPI:1851877294
Name:CARABALLO, JORGE II (LCMHC)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CARABALLO
Suffix:II
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 DANZANTE PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9365
Mailing Address - Country:US
Mailing Address - Phone:910-229-7248
Mailing Address - Fax:
Practice Address - Street 1:1931 J N PEASE PL STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4543
Practice Address - Country:US
Practice Address - Phone:704-885-0268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14060101YP2500X
NC14060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional