Provider Demographics
NPI:1508117631
Name:ADMP
Entity Type:Organization
Organization Name:ADMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALIFIED PROFESSIONAL
Authorized Official - Prefix:MS
Authorized Official - First Name:LETSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENERETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-323-0584
Mailing Address - Street 1:131 HAY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5649
Mailing Address - Country:US
Mailing Address - Phone:910-323-0584
Mailing Address - Fax:910-323-0566
Practice Address - Street 1:131 HAY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5649
Practice Address - Country:US
Practice Address - Phone:910-323-0584
Practice Address - Fax:910-323-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC026931251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health