NPIMap

Organization Active NPI

Carolina Outreach, LLC

  • Community/Behavioral Health Agency
  • Charlotte, NC
National Provider Identifier
1710687967
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CAROLINA OUTREACH, LLC
Practice address
2508 April Liu LN Apt 311
Charlotte, NC 28213-6966
Phone
(704) 332-8787
NPI assigned
Mar 7, 2023
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINA OUTREACH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
James Mitchell Vedder
Title
Cfo
Phone
(703) 844-1007

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

2508 April Liu LN Apt 311
Charlotte, NC 28213-6966

Mailing address

2670 Durham Chapel Hill Blvd
Durham, NC 27707-2829
Phone (720) 402-2296

Other identifiers 1

IdentifierTypeStateIssuer
08300219MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Carolina Outreach LLC19 organizations share this tax ID, including this one
Part of
Carolina Outreach LLC

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1710687967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 DURHAM CHAPEL HILL BLVD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072829",
            "telephone_number": "720-402-2296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 APRIL LIU LN APT 311",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282136966",
            "telephone_number": "704-332-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA OUTREACH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINA OUTREACH, LLC",
        "enumeration_date": "2023-03-07",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "VEDDER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MITCHELL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "703-844-1007"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08300219",
            "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 Mar 7, 2023; 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.