Healthcare Provider Details

I. General information

NPI: 1932570488
Provider Name (Legal Business Name): CARDINAL DIRECTIONS BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 TRIBUTE CENTER DR SUITE 135
RALEIGH NC
27612-3214
US

IV. Provider business mailing address

1300 TRIBUTE CENTER DR SUITE 135
RALEIGH NC
27612-3214
US

V. Phone/Fax

Practice location:
  • Phone: 919-917-3488
  • Fax:
Mailing address:
  • Phone: 919-917-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCAS-3115
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number1043564271
License Number StateNC

VIII. Authorized Official

Name: DANNY WAMSLEY
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, PHD-ABD, LCASA
Phone: 919-917-0609