Provider Demographics
NPI:1699151985
Name:CAROLINA COMPLETE PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:CAROLINA COMPLETE PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLZHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:704-503-9884
Mailing Address - Street 1:5950 FAIRVIEW ROAD
Mailing Address - Street 2:SUITE 708
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210
Mailing Address - Country:US
Mailing Address - Phone:704-503-9884
Mailing Address - Fax:704-870-3968
Practice Address - Street 1:5950 FAIRVIEW ROAD
Practice Address - Street 2:SUITE 708
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210
Practice Address - Country:US
Practice Address - Phone:704-503-9884
Practice Address - Fax:704-870-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0100-04002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty