Provider Demographics
NPI:1396960985
Name:CAROLINA COUNSELING GROUP, LLC
Entity type:Organization
Organization Name:CAROLINA COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:704-342-8390
Mailing Address - Street 1:1714 S TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4459
Mailing Address - Country:US
Mailing Address - Phone:704-342-8390
Mailing Address - Fax:704-342-8391
Practice Address - Street 1:1714 S TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4459
Practice Address - Country:US
Practice Address - Phone:704-342-8390
Practice Address - Fax:704-342-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty