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Organization
IMPACT CAROLINA SERVICES,INC
Active
Organization
IMPACT CAROLINA SERVICES,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ADEDOKUN PH.D. (DIRECTOR)
(704) 732-2006
Entity
Organization
Contact information
Practice address
1006 UNION ROAD, SUITE B, GASTONIA, NC 28054-0000
(704) 864-8775
(980) 225-0549
Mailing address
106 DOCTORS PARK, SUITE B, BOGER CITY, NC 28092-0000
(704) 732-2006
(704) 732-0303
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
795
NC
101YM0800X
Mental Health Counselor
Primary
C005215
NC
1041C0700X
Clinical Social Worker
CD07873
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
NC1809906
NC
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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