Organization
IMPACT COMMUNITY RESOURCES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLITA J RANDALL (CLINICAL DIRECTOR)
(412) 977-1273
Entity
Organization
Contact information
Practice address
301 MCCULLOUGH DR, CHARLOTTE, NC 28262-3310
(980) 276-5142
Mailing address
7911 BELLA VISTA CT, CHARLOTTE, NC 28216-2044
(704) 918-7966
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YS0200X
School Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
08/16/2022
Last updated
06/04/2025
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