Provider Demographics
NPI:1144524703
Name:CAROLINA COMMUNITY SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:CAROLINA COMMUNITY SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OSWALD
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-454-7725
Mailing Address - Street 1:4324 S ALSTON AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2696
Mailing Address - Country:US
Mailing Address - Phone:919-682-5777
Mailing Address - Fax:919-687-6975
Practice Address - Street 1:4324 S ALSTON AVE STE 113
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2696
Practice Address - Country:US
Practice Address - Phone:919-682-5777
Practice Address - Fax:919-687-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty