Provider Demographics
NPI:1558177154
Name:DEVEGA, CAROL (CADC 30581)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:DEVEGA
Suffix:
Gender:F
Credentials:CADC 30581
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 PIPERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4320
Mailing Address - Country:US
Mailing Address - Phone:919-463-2091
Mailing Address - Fax:
Practice Address - Street 1:1512 PIPERWOOD CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4320
Practice Address - Country:US
Practice Address - Phone:919-463-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30581101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty