Provider Demographics
NPI:1144251828
Name:CAROLINA COMPREHENSIVE PSYCHIATRIC SERVICES, PLLC
Entity type:Organization
Organization Name:CAROLINA COMPREHENSIVE PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-439-1011
Mailing Address - Street 1:1877 ALTONS TRL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4746
Mailing Address - Country:US
Mailing Address - Phone:252-439-1011
Mailing Address - Fax:252-940-0030
Practice Address - Street 1:216 STEWART PKWY
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4972
Practice Address - Country:US
Practice Address - Phone:252-439-1011
Practice Address - Fax:252-940-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005908Medicaid
NC017X0OtherBCBS GROUP
NC1144251828OtherGROUP NPI
NC1144251828OtherGROUP NPI
NC017X0OtherBCBS GROUP