Provider Demographics
NPI:1992034797
Name:CAROLINA OUTREACH, LLC
Entity Type:Organization
Organization Name:CAROLINA OUTREACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-251-9001
Mailing Address - Street 1:480 HILLSBORO ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-9497
Mailing Address - Country:US
Mailing Address - Phone:919-542-2093
Mailing Address - Fax:919-542-4042
Practice Address - Street 1:480 HILLSBORO ST
Practice Address - Street 2:SUITE 130
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-9497
Practice Address - Country:US
Practice Address - Phone:919-542-2093
Practice Address - Fax:919-542-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health