Provider Demographics
NPI:1669790051
Name:CAROLINA ACCESS SUPPORT AND ENRICHMENT SERVICES INC.
Entity type:Organization
Organization Name:CAROLINA ACCESS SUPPORT AND ENRICHMENT SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, QP
Authorized Official - Phone:704-200-9949
Mailing Address - Street 1:5108 REAGAN DR STE 10
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1395
Mailing Address - Country:US
Mailing Address - Phone:704-200-9949
Mailing Address - Fax:704-353-7233
Practice Address - Street 1:5108 REAGAN DR STE 10
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1395
Practice Address - Country:US
Practice Address - Phone:704-200-9949
Practice Address - Fax:704-353-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X, 251S00000X
SC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty