Provider Demographics
| NPI: | 1477870061 |
|---|---|
| Name: | CONNECTIONS BWB INC |
| Entity Type: | Organization |
| Organization Name: | CONNECTIONS BWB INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | SERVICES ANALYST |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | PHYLLIS |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | HOWARD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 704-596-5553 |
| Mailing Address - Street 1: | 8430 UNIVERSITY EXEC PARK DR |
| Mailing Address - Street 2: | SUITE 655 |
| Mailing Address - City: | CHARLOTTE |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28262-1350 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 704-596-5553 |
| Mailing Address - Fax: | 704-596-1556 |
| Practice Address - Street 1: | 8430 UNIVERSITY EXEC PARK DR |
| Practice Address - Street 2: | SUITE 655 |
| Practice Address - City: | CHARLOTTE |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 28262-1350 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 704-596-5553 |
| Practice Address - Fax: | 704-596-1556 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2010-04-23 |
| Last Update Date: | 2014-04-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 251S00000X, 101YP2500X, 103T00000X, 103TA0400X, 103TB0200X, 103TC1900X, 103TF0000X, 103TP0016X, 104100000X, 1041C0700X, 106H00000X, 251B00000X, 251S00000X | ||
| NC | 150 | 253J00000X, 253J00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 253J00000X | Agencies | Foster Care Agency | Group - Multi-Specialty | |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NC | 3410158 | Medicaid | |
| NC | 8301891 | Medicaid | |
| NC | 3410158 | Medicaid | |
| NC | 8301891G | Medicaid | |
| NC | 8303434 | Medicaid | |
| NC | 8703159 | Medicaid | |
| NC | 5914109 | Medicaid | |
| NC | 6006799 | Medicaid | |
| NC | 8301891H | Medicaid | |
| NC | 8301891B | Medicaid | |
| NC | 8303434H | Medicaid |
