Provider Demographics
NPI:1013183680
Name:ASSOCIATE BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:ASSOCIATE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:910-735-0556
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-0920
Mailing Address - Country:US
Mailing Address - Phone:910-735-0556
Mailing Address - Fax:910-735-0557
Practice Address - Street 1:206 E. 7TH STREET
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-735-0556
Practice Address - Fax:910-735-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 385HR2060X
NC251B00000X, 251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005212Medicaid
NC8300249HMedicaid
NC8300308HMedicaid
NC8300348Medicaid
NC8300348GMedicaid
NC8300308GMedicaid
NC8300348BMedicaid
NC3409650Medicaid
NC8300308BMedicaid