Provider Demographics
NPI:1366620684
Name:CAROLINA FAMILY NETWORK & THERAPEUTIC SVC
Entity type:Organization
Organization Name:CAROLINA FAMILY NETWORK & THERAPEUTIC SVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:SR
Authorized Official - Credentials:MASTER
Authorized Official - Phone:704-345-2032
Mailing Address - Street 1:311 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4453
Mailing Address - Country:US
Mailing Address - Phone:704-923-9005
Mailing Address - Fax:
Practice Address - Street 1:311 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4453
Practice Address - Country:US
Practice Address - Phone:704-865-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA TOTAL CARE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management