Provider Demographics
NPI:1497473086
Name:CEDRIC DEAN HOLDINGS INC.
Entity Type:Organization
Organization Name:CEDRIC DEAN HOLDINGS INC.
Other - Org Name:PEER SUPPORT NC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BEHAVIORAL HEALTH PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:SA, MH
Authorized Official - Phone:704-492-5509
Mailing Address - Street 1:5502 MCCHESNEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7188
Mailing Address - Country:US
Mailing Address - Phone:704-492-5509
Mailing Address - Fax:
Practice Address - Street 1:2001 CATHERINE SIMMONS AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4677
Practice Address - Country:US
Practice Address - Phone:704-492-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40411529OtherATYPICAL PROVIDER
NC1497473086Medicaid