MEDICARE: CAPE FEAR CASE MANAGEMENT & COUNSELING SERVICES LLC

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	6613	NC
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1457539264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE FEAR CASE MANAGEMENT & COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	4536 TECHNOLOGY DR
Second Line	:	SUITE 2
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2172
Country	:	US
Telephone Number	:	910-620-4373
Fax Number	:	910-399-6186

Provider Business Practice Location Address
First Line	:	4536 TECHNOLOGY DR
Second Line	:	SUITE 2
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2172
Country	:	US
Telephone Number	:	910-620-4121
Fax Number	:	910-632-9491

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JULIE SHAW
Credential	:
Telephone Number	:	910-620-4373

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	04/25/2012

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