Organization
IMPACT CAROLINA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ADEDOKUN PH.D. (CEO)
(704) 732-2006
Entity
Organization
Contact information
Practice address
1552 UNION RD, SUITE C, GASTONIA, NC 28054-5523
(704) 852-9210
(704) 852-9211
Mailing address
1552 UNION RD, SUITE C, GASTONIA, NC 28054-5523
(704) 852-9210
(704) 852-9211
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
795
NC
1041C0700X
Clinical Social Worker
C002728
NC
2084P0800X
Psychiatry Physician
Primary
NC 93-00472
NC
363L00000X
Nurse Practitioner
5004878
NC
363LA2200X
Adult Health Nurse Practitioner
5004910
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5004878
—
NC
05
—
5004910
—
NC
05
—
6003129
—
NC
05
—
6111767
—
NC
05
—
891036Y
—
NC
Enumeration date
04/04/2013
Last updated
04/04/2013
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