# IMPACT CAROLINA SERVICES,INC

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

## Provider details

- **NPI number:** 1780135681
- **Authorized official:** DR. JOSEPH ADEDOKUN PH.D. (DIRECTOR)
- **Authorized official phone:** (704) 732-2006

## Contact information

- **Practice address:** 1006 UNION ROAD, SUITE B, GASTONIA, NC 28054-0000
- **Practice address phone:** (704) 864-8775
- **Practice address fax:** (980) 225-0549
- **Mailing address:** 106 DOCTORS PARK, SUITE B, BOGER CITY, NC 28092-0000
- **Mailing address phone:** (704) 732-2006
- **Mailing address fax:** (704) 732-0303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 795 | NC | — |
| 101YM0800X | Mental Health Counselor | C005215 | NC | Yes |
| 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