Provider Demographics
NPI:1740463439
Name:CAROLINA'S THERAPY SOLUTIONS
Entity type:Organization
Organization Name:CAROLINA'S THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ECCLESTON
Authorized Official - Suffix:II
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-608-0445
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-0634
Mailing Address - Country:US
Mailing Address - Phone:704-608-0445
Mailing Address - Fax:
Practice Address - Street 1:1009 WICKERBY CT
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3738
Practice Address - Country:US
Practice Address - Phone:704-608-0445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003091Medicaid