Provider Demographics
NPI:1659653053
Name:CB RECOVERY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CB RECOVERY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-345-5020
Mailing Address - Street 1:21 ANNA DRIVE
Mailing Address - Street 2:SUITES 105 AND 106
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520
Mailing Address - Country:US
Mailing Address - Phone:919-585-5020
Mailing Address - Fax:919-158-5299
Practice Address - Street 1:21 ANNA DR.
Practice Address - Street 2:SUITES 105 & 106
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520
Practice Address - Country:US
Practice Address - Phone:919-585-5020
Practice Address - Fax:704-452-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-051-194251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health