Provider Demographics
NPI:1154494821
Name:ASSOCIATE BEHAVIORAL SERVICES, INC.
Entity Type:Organization
Organization Name:ASSOCIATE BEHAVIORAL SERVICES, INC.
Other - Org Name:ASSOCIATE COUNSELING CENTER
Other - Org Type:Other Name
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 1:325 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5526
Mailing Address - Country:US
Mailing Address - Phone:910-735-0556
Mailing Address - Fax:910-735-0557
Practice Address - Street 1:325 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5526
Practice Address - Country:US
Practice Address - Phone:910-735-0556
Practice Address - Fax:910-735-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-161101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300249BOtherCOMMUNITY SUPPORTS
NC8300308HOtherDX ASSESSMENT
NC6601365Medicaid
NC8300348GOtherDX ASSESSMENT
NC140JVOtherLPC PROVIDER
NC8988468Medicaid
NC136W3OtherLCSW
NC3409650Medicaid
NC6005212Medicaid
NC8300308BOtherCOMMUNITY SUPPORTS
NC6102230Medicaid
NC6102788Medicaid
NC8300249GOtherDX ASSESSMENT
NC8300348BOtherCOMMUNITY SUPPORTS
NC140JUOtherLPC PROVIDER
NC6002814Medicaid
NC6003212Medicaid
NC8300249HOtherIN HOME
NC8300348HOtherIN HOME