Healthcare Provider Details

I. General information

NPI: 1811066145
Provider Name (Legal Business Name): ALIDA S MASON LPC LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W EDINBOROUGH AVE
RAEFORD NC
28376-2825
US

IV. Provider business mailing address

PO BOX 35863
FAYETTEVILLE NC
28303-0863
US

V. Phone/Fax

Practice location:
  • Phone: 910-848-0700
  • Fax: 910-848-0222
Mailing address:
  • Phone: 910-221-5269
  • Fax: 910-221-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number243
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5199
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1347
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3183
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1738
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number36397
License Number StateNC

VIII. Authorized Official

Name: MR. JASON A TOWNSEND
Title or Position: BILLING MANAGER
Credential:
Phone: 910-860-7008