IMPACT CAROLINA SERVICESINC NPI 1780135681

NPI Information

NPI: 1780135681
Provider Name: IMPACT CAROLINA SERVICES,INC
Classification: Counselor - 101YM0800X
Entity Type: Organization

Specialization: Mental Health

Address:
1006 UNION ROAD
SUITE B
GASTONIA, NC
ZIP 28054
Phone: (704) 864-8775
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IMPACT CAROLINA SERVICES,INC is a mental health counselor in Gastonia, NC. IMPACT CAROLINA SERVICES,INC NPI is 1780135681. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1006 UNION ROAD
SUITE B
GASTONIA, NC
ZIP 28054-000
Phone: (704) 864-8775
Fax: (980) 225-0549

The provider's authorized official is Joseph Adedokun .
The authorized official title is Director and has the following contact phone number (704) 732-2006.

The enumeration date for this NPI number is 10/17/2016 and was last updated on 10/17/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	795	NORTH CAROLINA	No
2	1041C0700X	Social Worker	Clinical	CD07873	NORTH CAROLINA	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	NC1809906	NORTH CAROLINA	No
4	101YM0800X	Counselor	Mental Health	C005215	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	2347954	MEDICARE UPIN	NORTH CAROLINA
2	5918094	MEDICAID	NORTH CAROLINA
3	6008555	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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