MEDICARE: CCDP 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245365675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCDP INC

Provider Business Mailing Address
First Line	:	1900 US HIGHWAY 70 E STE C
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28560-6818
Country	:	US
Telephone Number	:	252-638-9046
Fax Number	:	252-638-9026

Provider Business Practice Location Address
First Line	:	1900 US HIGHWAY 70 E STE C
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28560-6818
Country	:	US
Telephone Number	:	252-638-9046
Fax Number	:	252-638-9026

Authorized Official
Title or Position	:	ASSISTANT DIRECTOR
Name	:	DONNA B DAVIS
Credential	:
Telephone Number	:	252-638-9046

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	06/16/2008

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Directions to “CCDP INC ” Practice Location

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