MEDICARE: SOUTH LUMBERTON DEVELOPMENT ASSOCIATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1114866332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH LUMBERTON DEVELOPMENT ASSOCIATION INC

Provider Business Mailing Address
First Line	:	130 SPEARMAN ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-7087
Country	:	US
Telephone Number	:	800-804-6185
Fax Number	:	910-230-5722

Provider Business Practice Location Address
First Line	:	130 SPEARMAN ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-7087
Country	:	US
Telephone Number	:	800-804-6185
Fax Number	:	910-230-5722

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR OF SERVICES
Name	:	DR. AHMED MALACHI ABDELAZIZ
Credential	:
Telephone Number	:	800-804-6185

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	04/08/2026

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