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General NPI Number Information
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NPI Number | 1548322175
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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 | 12/13/2006
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Last Update Date | 10/05/2007
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Provider Practice Location 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 | 28314-0237
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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 | PO BOX 40353 2151 SKIBO RD STE 100
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-0237
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 8300907
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 6603654
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 6603429
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4660
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1837
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1017
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License Number State | NC
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Taxonomy #7
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2513
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License Number State | NC
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Taxonomy #8
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5158
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License Number State | NC
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Taxonomy #9
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 6603654
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License Number State | NC
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Taxonomy #10
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 6603429
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License Number State | NC
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Taxonomy #11
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 6604172
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License Number State | NC
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Taxonomy #12
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8300907
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License Number State | NC
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