NPIMap

Organization Active NPI

Impact Carolina Services,Inc

  • Mental Health Counselor
  • Gastonia, NC
National Provider Identifier
1780135681
Registry record updated Oct 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
C005215 Issued in NC
Legal business name
IMPACT CAROLINA SERVICES,INC
Practice address
1006 Union Road
Suite B
Gastonia, NC 28054-0000
Phone
(704) 864-8775
Fax
(980) 225-0549
NPI assigned
Oct 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2016

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
Phone
(704) 732-2006

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 795 NC
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X C005215 NC Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X CD07873 NC
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X NC1809906 NC

Addresses

Primary practice location

1006 Union Road
Suite B
Gastonia, NC 28054-0000

Mailing address

106 Doctors Park
Suite B
Boger City, NC 28092-0000
Phone (704) 732-2006

Other identifiers 2

IdentifierTypeStateIssuer
5918094MedicaidNC
6008555MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Impact Carolina Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

106 Doctors Park
Ste B
Boger City, NC 28092

1006 Union Rd
Ste B
Gastonia, NC 28054
Phone (704) 864-8775

NPI Registry JSON

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1780135681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 DOCTORS PARK",
            "address_2": "SUITE B",
            "city": "BOGER CITY",
            "state": "NC",
            "postal_code": "280920000",
            "telephone_number": "704-732-2006",
            "fax_number": "704-732-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 UNION ROAD",
            "address_2": "SUITE B",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280540000",
            "telephone_number": "704-864-8775",
            "fax_number": "980-225-0549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT CAROLINA SERVICES,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "ADEDOKUN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-732-2006",
        "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": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "C005215",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "CD07873",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "NC1809906",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5918094",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008555",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2016; 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.