Provider Demographics
NPI:1508801663
Name:ADVANTAGE PSYCHIATRY & COUNSELING
Entity Type:Organization
Organization Name:ADVANTAGE PSYCHIATRY & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-371-1007
Mailing Address - Street 1:1003 OLD WATERFORD WAY
Mailing Address - Street 2:STE 1C
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4102
Mailing Address - Country:US
Mailing Address - Phone:910-371-1007
Mailing Address - Fax:910-371-6003
Practice Address - Street 1:1003 OLD WATERFORD WAY
Practice Address - Street 2:STE 1C
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4102
Practice Address - Country:US
Practice Address - Phone:910-371-1007
Practice Address - Fax:910-371-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139H9OtherBCBS GROUP
NC141MVOtherBCBS GROUP
NC6005840Medicaid
NC5900767Medicaid
NC141MVOtherBCBS GROUP
NC6005840Medicaid
NC139H9OtherBCBS GROUP
NCI30556Medicare UPIN