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General NPI Number Information
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NPI Number | 1083257562
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Entity Type | Organization
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Legal Business Name | OMNI BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 209 MARTIN LUTHER KING JR. DR.
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-2833
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Country | US
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Telephone | 910-247-6822
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Fax | 910-247-6829
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Provider Business Mailing Address
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Address Line | 209 MARTIN LUTHER KING JR. DR.
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City | ELIZABETHTOWN
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State | NC
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Zip | 28352
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Country | US
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Telephone | 910-247-6822
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Fax | 910-247-6829
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Authorized Official
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Title or Position | SENIOR ADMINISTRATOR
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Name | JOHN A JACKSON
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Credential |
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Telephone | 910-247-6822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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