Healthcare Provider Details

I. General information

NPI: 1750412516
Provider Name (Legal Business Name): COUNTY OF CUMBERLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 ROXIE AVE
FAYETTEVILLE NC
28304-1623
US

IV. Provider business mailing address

PO BOX 3069
FAYETTEVILLE NC
28302-3069
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-0601
  • Fax: 910-323-0096
Mailing address:
  • Phone: 910-323-0601
  • Fax: 910-323-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-026-107
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-026-107
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DENSIE D LUCAS
Title or Position: ASSISTANT AREA DIRECTOR
Credential:
Phone: 910-323-0601