Provider Demographics
NPI:1376781674
Name:DIRECCARE BEHAVIORAL SERVICES, INC
Entity Type:Organization
Organization Name:DIRECCARE BEHAVIORAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-1818
Mailing Address - Street 1:506 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3920
Mailing Address - Country:US
Mailing Address - Phone:910-738-1818
Mailing Address - Fax:910-738-1817
Practice Address - Street 1:506 E 22ND ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3920
Practice Address - Country:US
Practice Address - Phone:910-738-1818
Practice Address - Fax:910-738-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health