NPIMap

Organization Active NPI

Carolina Outreach

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Charlotte, NC
National Provider Identifier
1407585706
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CAROLINA OUTREACH
Practice address
5108 Reagan Dr
Charlotte, NC 28206-3103
Phone
(704) 332-8787
NPI assigned
Jun 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeremy Fitzgerald, MSNPI 1790346021
Title
Intensive in-Home Therapist
Phone
(704) 565-9538

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

5108 Reagan Dr
Charlotte, NC 28206-3103

Mailing address

5108 Reagan Dr
Charlotte, NC 28206-3103
Phone (704) 332-8787

National Provider Directory

National Provider Directory

Locations

5108 Reagan Dr
Charlotte, NC 28206
Phone (704) 332-8787

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1407585706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5108 REAGAN DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282063103",
            "telephone_number": "704-332-8787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5108 REAGAN DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282063103",
            "telephone_number": "704-332-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA OUTREACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "INTENSIVE IN-HOME THERAPIST",
        "authorized_official_telephone_number": "704-565-9538",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.