Healthcare Provider Details

I. General information

NPI: 1801901129
Provider Name (Legal Business Name): CASCADE BEHAVIORAL TREATMENT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CLIFTON ST
GREENVILLE NC
27858-5005
US

IV. Provider business mailing address

PO BOX 8344
GREENVILLE NC
27835-8344
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 Code251B00000X
TaxonomyCase Management Agency
License NumberMHL-074-155
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-074-155
License Number StateNC

VIII. Authorized Official

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