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NPI Code Detail

MEDICARE: CAPE FEAR BEHAVIORAL HEALTH CENTER LLC

MEDICARE: CAPE FEAR BEHAVIORAL HEALTH CENTER 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
1101YM0800XMental Health Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1790062057
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAPE FEAR BEHAVIORAL HEALTH CENTER LLC
Provider Business Mailing Address
First Line : 6885 CLIFFDALE RD STE 202
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28314-2834
Country : US
Telephone Number : 910-339-0400
Fax Number : 910-339-0396
Provider Business Practice Location Address
First Line : 6885 CLIFFDALE RD STE 202
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28314-2834
Country : US
Telephone Number : 910-339-0400
Fax Number : 910-339-0396
Authorized Official
Title or Position : MEMBER/MANAGER
Name : DR. ANGELA ELIZABETH KIDD
Credential :
Telephone Number : 910-339-0400
Provider Enumeration Date : 11/14/2011
Last Update Date : 10/03/2014

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