=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306121645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY-BASED DEVELOPMENTAL SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2011
-----------------------------------------------------
Last Update Date | 12/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3274 ROSEHILL RD SUITE 2
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28301-3005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-488-5820
-----------------------------------------------------
Fax | 910-488-5837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1735 SLATER AVE
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28301-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-488-4584
-----------------------------------------------------
Fax | 910-630-3169
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. CYNTHIA B. BILLOPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-488-4584
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------