Provider Demographics
NPI:1891203212
Name:CAROLINA FAMILY COUNSELING, PLLC
Entity Type:Organization
Organization Name:CAROLINA FAMILY COUNSELING, PLLC
Other - Org Name:CAROLINA FAMILY COUNSELING, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:704-249-0108
Mailing Address - Street 1:1910 MADEIRA CIR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7198
Mailing Address - Country:US
Mailing Address - Phone:704-249-0108
Mailing Address - Fax:866-387-6955
Practice Address - Street 1:325 MATTHEWS MINT HILL RD STE 112
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-0004
Practice Address - Country:US
Practice Address - Phone:704-249-0108
Practice Address - Fax:866-387-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0036321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002286Medicaid