Provider Demographics
NPI:1932118023
Name:COTTO, CAROLINE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANN
Last Name:COTTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:KISSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1312 MATTHEWS MINT HILL RD # 205
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4212
Mailing Address - Country:US
Mailing Address - Phone:252-917-2775
Mailing Address - Fax:
Practice Address - Street 1:1312 MATTHEWS MINT HILL RD # 205
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4212
Practice Address - Country:US
Practice Address - Phone:252-917-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1617101YA0400X
NCC0051911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
152 NGOtherBCBS
NC1932118023Medicaid
NC1932118023Medicaid