Provider Demographics
NPI:1447705389
Name:LARGO, CAROLYNE (MS, MED)
Entity type:Individual
Prefix:MRS
First Name:CAROLYNE
Middle Name:
Last Name:LARGO
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:CAROLYNE
Other - Middle Name:
Other - Last Name:ABELLERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28368-0434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:480 SEAWELL ROSSER RD
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28368
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8238106E00000X
NCLCAS-27035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst