Healthcare Provider Details

I. General information

NPI: 1760734495
Provider Name (Legal Business Name): ARJ LLC #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 MURCHISON RD STE 3&4
FAYETTEVILLE NC
28301-3567
US

IV. Provider business mailing address

2215 MURCHISON RD STE 3&4
FAYETTEVILLE NC
28301
US

V. Phone/Fax

Practice location:
  • Phone: 910-703-8710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. ALVIN JASPER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 704-910-5395