Healthcare Provider Details

I. General information

NPI: 1457539264
Provider Name (Legal Business Name): CAPE FEAR CASE MANAGEMENT & COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4536 TECHNOLOGY DR SUITE 2
WILMINGTON NC
28405-2172
US

IV. Provider business mailing address

4536 TECHNOLOGY DR SUITE 2
WILMINGTON NC
28405-2172
US

V. Phone/Fax

Practice location:
  • Phone: 910-620-4121
  • Fax: 910-632-9491
Mailing address:
  • Phone: 910-620-4373
  • Fax: 910-399-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6613
License Number StateNC

VIII. Authorized Official

Name: MS. JULIE SHAW
Title or Position: OWNER
Credential:
Phone: 910-620-4373