Organization
IMPACT CAROLINA SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH OLATUNDE ADEDOKUN PH.D. (CHIEF EXECUTIVE OFFICER)
(704) 533-0277
Entity
Organization
Contact information
Practice address
106 DOCTORS PARK, LINCOLNTON, NC 28092-4406
(704) 533-0277
(704) 685-5937
Mailing address
3080 JAMESTOWN DR, GASTONIA, NC 28054-6056
(704) 533-0277
(704) 864-3355
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
795
NC
101YM0800X
Mental Health Counselor
Primary
795
NC
101YP2500X
Professional Counselor
795
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6111767
—
NC
Enumeration date
01/05/2009
Last updated
01/05/2009
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