Healthcare Provider Details

I. General information

NPI: 1669608592
Provider Name (Legal Business Name): CASCADE BEHAVIORAL TREATMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CLIFTON ST
GREENVILLE NC
27858-5005
US

IV. Provider business mailing address

325 CLIFTON ST
GREENVILLE NC
27858-5005
US

V. Phone/Fax

Practice location:
  • Phone: 252-758-2065
  • Fax: 252-758-2084
Mailing address:
  • Phone: 252-758-2065
  • Fax: 252-758-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHL074155
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberMHL074155
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMHL074155
License Number StateNC

VIII. Authorized Official

Name: MS. WANDA TERESA WILLIAMS
Title or Position: DIRECTOR
Credential: MS, LCAS
Phone: 252-758-2065