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Organization

CAROLINAS MEDICAL CENTER-NORTHEAST

Active
Parent organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Other names
NorthEast Psychiatric Services - Harrisburg
Organization subpart
Yes

Provider details

NPI number
Legal business name
CAROLINAS MEDICAL CENTER-NORTHEAST
Authorized official
FRIEDA M LOWDER (SR. VICE PRESIDENT)
(704) 403-1780
Entity
Organization

Contact information

Practice address
5427 HIGHWAY 49 S, SUITE 105, HARRISBURG, NC 28075-7408
(704) 454-7268
(704) 455-4990
Mailing address
5427 HIGHWAY 49 S, SUITE 105, HARRISBURG, NC 28075-7408
(704) 454-7268
(704) 455-4990

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YP2500X
Professional Counselor
103T00000X
Psychologist
103TA0400X
Addiction (Substance Use Disorder) Psychologist
103TC0700X
Clinical Psychologist
103TC2200X
Clinical Child & Adolescent Psychologist
103TF0000X
Family Psychologist
104100000X
Social Worker
106H00000X
Marriage & Family Therapist
2084P0800X
Psychiatry Physician
Primary
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
019G5
BCBS EFF 7-1-07
NC
01
355573
MAMSI
NC
01
566000156057
TRICARE STANDARD, NON NWK
NC
05
5906958
NC
01
6005328
GROUP NO FOR LCSW & PHD
NC
05
6006310
NC
05
89015E8
NC
01
B948
PARTNERS MEDICARE CHOICE
NC
01
CC2854
RAILROAD MEDICARE
NC
01
DF8926
RAILROAD MEDICARE PTAN
NC
Enumeration date
01/19/2007
Last updated
09/25/2013
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