Provider Demographics
NPI:1780060723
Name:UNC ADDICTION DETOX UNIT
Entity type:Organization
Organization Name:UNC ADDICTION DETOX UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL INSTRUCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:984-974-4861
Mailing Address - Street 1:107 SUNNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1827
Mailing Address - Country:US
Mailing Address - Phone:984-974-4861
Mailing Address - Fax:
Practice Address - Street 1:107 SUNNYBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1827
Practice Address - Country:US
Practice Address - Phone:984-974-4861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder