Organization
CAROLINA COMMUNITY INTERVENTION SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERARD J COLLINS (CHIEF EXECUTIVE OFFICER)
(847) 887-9051
Entity
Organization
Contact information
Practice address
2028 RENNER ST, CHARLOTTE, NC 28216-5168
(847) 887-9051
Mailing address
2028 RENNER ST, CHARLOTTE, NC 28216-5168
(847) 887-9051
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/07/2011
Last updated
06/15/2015
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