Provider Demographics
NPI: | 1700041597 |
---|---|
Name: | ACCESS BEHAVIORAL ASSISTANCE INC |
Entity Type: | Organization |
Organization Name: | ACCESS BEHAVIORAL ASSISTANCE INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VICE PRESIDENT |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | RACHEL |
Authorized Official - Middle Name: | BETH |
Authorized Official - Last Name: | PURNELL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | P LCSW |
Authorized Official - Phone: | 910-219-1223 |
Mailing Address - Street 1: | 1703 COUNTRY CLUB RD |
Mailing Address - Street 2: | SUITE 304 |
Mailing Address - City: | JACKSONVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28546-6008 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-219-1223 |
Mailing Address - Fax: | 910-219-1205 |
Practice Address - Street 1: | 1703 COUNTRY CLUB RD |
Practice Address - Street 2: | SUITE 304 |
Practice Address - City: | JACKSONVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28546-6008 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-219-1223 |
Practice Address - Fax: | 910-219-1205 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-07-22 |
Last Update Date: | 2008-07-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | |
No | 251B00000X | Agencies | Case Management |