MEDICARE: CB RECOVERY 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	103TP0016X	Prescribing (Medical) Psychologist		NC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811255037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CB RECOVERY SERVICES, LLC

Provider Business Mailing Address
First Line	:	901 TOWN CENTRE BLVD
Second Line	:	SUITE 120
City	:	CLAYTON
State	:	NC
Zip	:	27520-2181
Country	:	US
Telephone Number	:	919-585-5020
Fax Number	:	919-550-5175

Provider Business Practice Location Address
First Line	:	21 ANNA DRIVE
Second Line	:	SUITE 105 AND 106
City	:	CLAYTON
State	:	NC
Zip	:	27520-2181
Country	:	US
Telephone Number	:	919-585-5020
Fax Number	:	919-550-5175

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. EUGENIA VALISHA DAVIS
Credential	:	LPC, LCAS
Telephone Number	:	919-585-4486

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	07/21/2022

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