Provider Demographics
NPI:1679956601
Name:CAROLINA OUTREACH, LLC
Entity type:Organization
Organization Name:CAROLINA OUTREACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-251-9001
Mailing Address - Street 1:3325 DURHAM CHAPEL HILL BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2646
Mailing Address - Country:US
Mailing Address - Phone:919-338-0939
Mailing Address - Fax:984-888-0913
Practice Address - Street 1:3325 DURHAM CHAPEL HILL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2646
Practice Address - Country:US
Practice Address - Phone:919-338-0939
Practice Address - Fax:984-888-0913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA OUTREACH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health