Provider Demographics
NPI:1912069303
Name:CAROLINA CENTER FOR AUTISM SERVICES, LLC
Entity type:Organization
Organization Name:CAROLINA CENTER FOR AUTISM SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO & COO
Authorized Official - Prefix:
Authorized Official - First Name:XICOTENCAL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:GARCILAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-440-7029
Mailing Address - Street 1:111 MACKENAN DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-7903
Mailing Address - Country:US
Mailing Address - Phone:919-371-2848
Mailing Address - Fax:
Practice Address - Street 1:111 MACKENAN DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7903
Practice Address - Country:US
Practice Address - Phone:919-371-2848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty