Provider Demographics
NPI:1215082748
Name:WINSTON, CAROLE ANNE (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:ANNE
Last Name:WINSTON
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9238 KESTRAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6169
Mailing Address - Country:US
Mailing Address - Phone:704-992-1020
Mailing Address - Fax:336-750-2699
Practice Address - Street 1:831 BAXTER ST
Practice Address - Street 2:220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2887
Practice Address - Country:US
Practice Address - Phone:704-373-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404913OtherPRE-APPROVAL NUMBER
NC6106266Medicaid