# CAROLINA'S MEDICAL & WELLNESS CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134987100
- **Authorized official:** MRS. JENNIFER COUGHENOUR FNP (OWNER)
- **Authorized official phone:** (910) 506-8474

## Contact information

- **Practice address:** 821A S MAIN ST, LAURINBURG, NC 28352-4724
- **Practice address phone:** (910) 506-8474
- **Practice address fax:** (855) 736-1881
- **Mailing address:** 821A S MAIN ST, LAURINBURG, NC 28352-4724
- **Mailing address phone:** (910) 506-8474
- **Mailing address fax:** (855) 736-1881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |
| 363LX0106X | Occupational Health Nurse Practitioner | — | NULL | — |
| 363LX0106X | Occupational Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/13/2024
- **Last updated:** 08/05/2025