NPIMap

Organization Active NPI

Impact Carolina Services Inc

  • Addiction (Substance Use Disorder) Counselor
  • Gastonia, NC
National Provider Identifier
1861941049
Registry record updated Sep 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
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
Sep 28, 2016
Last updated
Sep 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2016

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

Authorized official

Name
Dr. Joseph O Adedokun, PH.D.
Title
Director
Phone
(704) 732-2006

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NC
Addiction (Substance Use Disorder) Counselor 101YA0400X NC Primary
Psychiatry Physician 2084P0800X NC

Addresses

Primary practice location

1006 Union Road
Suite B
Gastonia, NC 28054-0000

Mailing address

1006 Union Road
Suite B
Gastonia, NC 28054-0000
Phone (704) 864-8775

Other identifiers 1

IdentifierTypeStateIssuer
6006650MedicaidNC

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

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": "1475020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1861941049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "2016-09-28",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "ADEDOKUN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "O",
        "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": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006650",
            "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 Sep 28, 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.