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General NPI Number Information
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NPI Number | 1932832557
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Entity Type | Organization
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Legal Business Name | REBOOT BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 3011 TOWN CENTER DR STE 130 UNIT #122
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City | FAYETTEVILLE
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State | NC
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Zip | 28306
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Country | US
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Telephone | 910-727-4590
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Fax | 910-407-9529
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Provider Business Mailing Address
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Address Line | 5917 FUCHSIA CT
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City | STEDMAN
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State | NC
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Zip | 28391-3401
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Country | US
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Telephone | 910-305-8893
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERICA T POWELL
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Credential | LCSWA
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Telephone | 910-305-8893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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