Active NPI
Impact Carolina Services, Inc
- Psychiatry Physician
- Charlotte, NC
National Provider Identifier
1619285756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- NC 2005-00391
- Legal business name
- IMPACT CAROLINA SERVICES, INC
- Practice address
- 2848 Queen City Dr Ste G
Charlotte, NC 28208-2739 - Phone
- (704) 405-1617
- Fax
- (704) 405-1619
- NPI assigned
- Sep 23, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Joseph Adedokun, PH.D.
- Title
- Director/Ceo
- Phone
- (704) 405-1617
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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 795 | NC | |
| Professional Counselor | 101YP2500X | 5171 | NC | |
| Clinical Social Worker | 1041C0700X | C001664 | NC | |
| Psychiatry Physician | 2084P0800X | NC 2005-00391 | NC | Primary |
| Adult Health Nurse Practitioner | 363LA2200X | 0600071 | NC |
Addresses
Primary practice location
2848 Queen City Dr Ste G
Charlotte, NC 28208-2739
Mailing address
2848 Queen City Dr Ste G
Charlotte, NC 28208-2739
Phone (704) 405-1617
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6006650 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Impact Carolina Services
Other organizations with this tax ID 5
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Gastonia, NC
- NPI 1194973586
-
- Psychiatry Physician
- Gastonia, NC
- NPI 1629311063
-
- Addiction (Substance Use Disorder) Counselor
- Gastonia, NC
- NPI 1861941049
-
- Mental Health Counselor
- Lincolnton, NC
- NPI 1376789925
-
- Mental Health Counselor
- Gastonia, NC
- NPI 1780135681
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Addiction (Substance Use Disorder) Counselor
- Gastonia, NC
- NPI 1760542062
-
- Psychiatric/Mental Health Nurse Practitioner
- Durham, NC
- NPI 1326462524
-
- Psychiatric/Mental Health Nurse Practitioner
- Lancaster, SC
- NPI 1285379081
-
- Professional Counselor
- Charlotte, NC
- NPI 1811010622
-
- Psychiatry Physician
- Gastonia, NC
- NPI 1447200183
-
- Psychiatry Physician
- Charlotte, NC
- NPI 1538246814
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285200000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1285200000000",
"number": "1619285756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2848 QUEEN CITY DR STE G",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282082739",
"telephone_number": "704-405-1617",
"fax_number": "704-405-1619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2848 QUEEN CITY DR STE G",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282082739",
"telephone_number": "704-405-1617",
"fax_number": "704-405-1619"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IMPACT CAROLINA SERVICES, INC",
"organizational_subpart": "NO",
"enumeration_date": "2010-09-23",
"last_updated": "2010-09-23",
"status": "A",
"authorized_official_last_name": "ADEDOKUN",
"authorized_official_first_name": "JOSEPH",
"authorized_official_title_or_position": "DIRECTOR/CEO",
"authorized_official_telephone_number": "704-405-1617",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PH.D."
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "795",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "NC",
"license": "5171",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C001664",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NC",
"license": "NC 2005-00391",
"primary": true
},
{
"code": "363LA2200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Adult Health",
"state": "NC",
"license": "0600071",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6006650",
"state": "NC"
}
],
"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 Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.