Impact Carolina Services, Inc

LBN: Impact Carolina Services, Inc
Impact Carolina Services, Inc is an health care organization with primary practice located at 2848 Queen City Dr Ste G , Charlotte NC 28208-2739. The organization recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Clinical, Allopathic & Osteopathic Physicians / Psychiatry, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Allopathic & Osteopathic Physicians / Psychiatry is the primary health care specialty. Impact Carolina Services, Inc can be contacted via phone (704) 405-1617, or through Adedokun, Joseph via phone (704) 405-1617.

Contact Information

Primary practice address
2848 Queen City Dr Ste G Charlotte NC 28208-2739
Phone: (704) 405-1617
Fax: (704) 405-1619
Website:
Map and Directions
Authorized official contact:
Name: Adedokun, Joseph PH.D.
Phone: (704) 405-1617

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 795 North Carolina
Behavioral Health & Social Service Providers / Professional 101YP2500X 5171 North Carolina
Behavioral Health & Social Service Providers / Clinical 1041C0700X C001664 North Carolina
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X NC 2005-00391 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 0600071 North Carolina

Profile Details

NPI number 1619285756
LBN Legal business name Impact Carolina Services, Inc
DBA Doing business as
Authorized official Adedokun, Joseph PH.D.
Entity Organization
Organization subpart 1 No
Enumeration date Sep 23rd, 2010
Last updated Sep 23rd, 2010 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619285756 NPPES
North Carolina MEDICAID 6006650

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