Organization
IMPACT CAROLINA SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ADEDOKUN PH.D. (DIRECTOR/CEO)
(704) 405-1617
Entity
Organization
Contact information
Practice address
2848 QUEEN CITY DR STE G, CHARLOTTE, NC 28208-2739
(704) 405-1617
(704) 405-1619
Mailing address
2848 QUEEN CITY DR STE G, CHARLOTTE, NC 28208-2739
(704) 405-1617
(704) 405-1619
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
795
NC
101YP2500X
Professional Counselor
5171
NC
1041C0700X
Clinical Social Worker
C001664
NC
2084P0800X
Psychiatry Physician
Primary
NC 2005-00391
NC
363LA2200X
Adult Health Nurse Practitioner
0600071
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006650
—
NC
Enumeration date
09/23/2010
Last updated
09/23/2010
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