Provider Demographics
NPI:1649783200
Name:CAROLINA ENEREGTICS PC
Entity type:Organization
Organization Name:CAROLINA ENEREGTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:AUTUMN
Authorized Official - Last Name:JUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-762-9630
Mailing Address - Street 1:310 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3328
Mailing Address - Country:US
Mailing Address - Phone:704-762-9630
Mailing Address - Fax:919-576-1372
Practice Address - Street 1:310 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3328
Practice Address - Country:US
Practice Address - Phone:704-762-9630
Practice Address - Fax:919-576-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25525101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty