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General NPI Number Information
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NPI Number | 1669514683
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Entity Type | Organization
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Legal Business Name | ROBESON HEALTH CARE CORPORATION
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 3750 MEADOW VIEW RD APT. A-1
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City | LUMBERTON
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State | NC
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Zip | 28358-1920
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Country | US
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Telephone | 910-618-9912
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Fax | 910-618-0728
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Provider Business Mailing Address
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Address Line | 60 COMMERCE PLAZA
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City | PEMBROKE
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State | NC
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Zip | 28372-2590
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Country | US
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Telephone | 910-521-2900
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Fax | 910-775-9164
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Authorized Official
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Title or Position | VP/CHIEF OF BEHAVIORAL HEALTH SVCS
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Name | MR. TIM HALL
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Credential | M.DIV.
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Telephone | 910-521-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MHL-078-111
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | MHL-078-111
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL-078-111
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License Number State | NC
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