Provider Demographics
NPI:1295515310
Name:CAROUSEL PROJECT, COMMUNITY CARE COUNSELING CENTER
Entity type:Organization
Organization Name:CAROUSEL PROJECT, COMMUNITY CARE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYLENE
Authorized Official - Middle Name:SCHOLL
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MCOUNS,EDD, CANDID
Authorized Official - Phone:503-991-3588
Mailing Address - Street 1:6994 SUNNYSIDE RD S.
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306
Mailing Address - Country:US
Mailing Address - Phone:503-991-3588
Mailing Address - Fax:
Practice Address - Street 1:6994 SUNNYSIDE RD S.
Practice Address - Street 2:1043 TWINWOOD CT NW
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306
Practice Address - Country:US
Practice Address - Phone:503-991-3588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROUSEL PROJECT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty