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General NPI Number Information
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NPI Number | 1285821082
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Entity Type | Organization
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Legal Business Name | GREAT EXPECTATIONS MENTAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 6611 CARLOWAY DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2768
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Country | US
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Telephone | 910-860-3325
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Fax | 910-860-3345
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Provider Business Mailing Address
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Address Line | 2151 SKIBO RD SUITE 100
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-0252
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Country | US
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Telephone | 910-860-3325
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Fax | 910-860-3345
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | MR. ANTHONY CHARLES PACKER
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Credential |
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Telephone | 910-860-3325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL026838
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License Number State | NC
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