Organization
CAROLINE OUTPATIENT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHERONDA W. WINGO (CEO/DIRECTOR)
(804) 589-0022
Entity
Organization
Contact information
Practice address
7120 CONWAY PLACE, RUTHER GLEN, VA 22546
(804) 305-5954
Mailing address
PO BOX 615, LADYSMITH, VA 22501-0615
(804) 305-5954
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/13/2007
Last updated
12/13/2007
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