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General NPI Number Information
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NPI Number | 1710350343
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Entity Type | Organization
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Legal Business Name | GREATER IMAGE HEALTHCARE, INC.
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 401 ROBESON ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5635
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Country | US
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Telephone | 910-321-0069
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Fax | 910-491-1000
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Provider Business Mailing Address
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Address Line | 401 ROBESON ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5635
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Country | US
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Telephone | 910-321-0069
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Fax | 910-491-1000
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Authorized Official
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Title or Position | SUBSTANCE ABUSE COUNSELOR
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Name | MRS. DEBRA D KEMP-HENDRICKS
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Credential | LCAS-R
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Telephone | 910-321-0069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | NC
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