Provider Demographics
NPI:1922431089
Name:CAROLINA OUTREACH, LLC
Entity Type:Organization
Organization Name:CAROLINA OUTREACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:VEDDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-844-1007
Mailing Address - Street 1:1001A HARDEE RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-3323
Mailing Address - Country:US
Mailing Address - Phone:910-298-7167
Mailing Address - Fax:
Practice Address - Street 1:1001A HARDEE RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-3323
Practice Address - Country:US
Practice Address - Phone:910-298-7167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3410049251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health