Provider Demographics
NPI:1992025860
Name:SUWS OF THE CAROLINAS
Entity Type:Organization
Organization Name:SUWS OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MADAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:828-668-7590
Mailing Address - Street 1:363 GRAPHITE RD
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-9455
Mailing Address - Country:US
Mailing Address - Phone:828-668-7590
Mailing Address - Fax:828-668-3162
Practice Address - Street 1:363 GRAPHITE RD
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762-9455
Practice Address - Country:US
Practice Address - Phone:828-668-7590
Practice Address - Fax:828-668-3162
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-059-032322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children