MEDICARE: ACADEMY1

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101200000X	Drama Therapist
2	101YS0200X	School Counselor
3	103TB0200X	Cognitive & Behavioral Psychologist
4	104100000X	Social Worker
5	172A00000X	Driver
6	251E00000X	Home Health Agency
7	364SS0200X	School Clinical Nurse Specialist
8	376J00000X	Homemaker
9	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1396689816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADEMY1

Provider Business Mailing Address
First Line	:	429 PERSON ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 PERSON ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5737
Country	:	US
Telephone Number	:	910-401-8797
Fax Number	:

Authorized Official
Title or Position	:	EDUCATIONAL SPECIALIST
Name	:	KARLISHIA ROSS
Credential	:
Telephone Number	:	910-401-8797

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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