Provider Demographics
NPI:1922278043
Name:CAROLINA FAMILY ALLIANCE, INC.
Entity Type:Organization
Organization Name:CAROLINA FAMILY ALLIANCE, INC.
Other - Org Name:CFA, INC.-RISE PROGRAM/PSR
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:704-536-9378
Mailing Address - Street 1:1235 EAST BLVD
Mailing Address - Street 2:#242
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5870
Mailing Address - Country:US
Mailing Address - Phone:704-536-9378
Mailing Address - Fax:704-536-9359
Practice Address - Street 1:9105 MONROE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1644
Practice Address - Country:US
Practice Address - Phone:704-536-9378
Practice Address - Fax:704-536-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
NC060-1177251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008015Medicaid
NC5914573Medicaid
NC8303125Medicaid
NC8302432Medicaid