Organization
CAROLINA CHOICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DONNA SIMON (BILLING OFFICER)
(252) 633-3855
Entity
Organization
Contact information
Practice address
5353 RED TIP RD, SUITE 111, FAYETTEVILLE, NC 28314-1567
(910) 485-0330
(910) 482-0330
Mailing address
PO BOX 12189, NEW BERN, NC 28561-2189
(252) 633-3855
(252) 633-1548
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301024
—
NC
05
—
8301024B
—
NC
05
—
8301024H
—
NC
Enumeration date
02/26/2007
Last updated
09/17/2010
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