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General NPI Number Information
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NPI Number | 1134320427
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Entity Type | Organization
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Legal Business Name | CLINICAL SERVICES ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 LAMON ST STE 212
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4957
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Country | US
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Telephone | 910-429-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 111 LAMON ST STE 212
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4957
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DORIS ANN MOORE-RUSSELL
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Credential | MSW LCSW
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Telephone | 910-429-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C004369
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License Number State | NC
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