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General NPI Number Information
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NPI Number | 1255539870
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Entity Type | Organization
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Legal Business Name | CUMBERLAND COUNTY COMMUNICARE, INC
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 711B EXECUTIVE PL
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5125
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Country | US
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Telephone | 910-222-6395
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 87830
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-7830
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Country | US
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Telephone | 910-222-6395
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ROBIN JENKINS
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Credential | PHD
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Telephone | 910-829-9017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL-026821
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License Number State | NC
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