Healthcare Provider Details

I. General information

NPI: 1952554388
Provider Name (Legal Business Name): STEPHENS OUTREACH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405A DUNN RD
LUMBERTON NC
28358-7913
US

IV. Provider business mailing address

405A DUNN RD
LUMBERTON NC
28358-7913
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-7865
  • Fax: 910-738-7876
Mailing address:
  • Phone: 910-738-7865
  • Fax: 910-738-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL078149
License Number StateNC

VIII. Authorized Official

Name: ALICIA SHEREESE MOORE
Title or Position: CEO
Credential: LCMHCS, LCAS
Phone: 910-738-7865