Provider Demographics
NPI:1114123635
Name:CASCADE BEHAVIORAL TREATMENT SERVICES, INC
Entity Type:Organization
Organization Name:CASCADE BEHAVIORAL TREATMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:252-758-2065
Mailing Address - Street 1:325 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5005
Mailing Address - Country:US
Mailing Address - Phone:252-758-2065
Mailing Address - Fax:252-758-2084
Practice Address - Street 1:325 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5005
Practice Address - Country:US
Practice Address - Phone:252-758-2065
Practice Address - Fax:252-758-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL074155101YA0400X, 101YP2500X, 103TC0700X, 1041C0700X
NCMH074115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911378Medicaid
NC8300208Medicaid
NC8300208RMedicaid
NC6005919Medicaid
NC6604056Medicaid
NC8300206GMedicaid
NC8300208BMedicaid
NC8300208HMedicaid
NC8300208PMedicaid
NC8300208QMedicaid