Provider Demographics
NPI:1740396779
Name:COMMUNITY-BASED DEVELOPMENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:COMMUNITY-BASED DEVELOPMENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:BRIDGERS
Authorized Official - Last Name:BILLOPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-488-4584
Mailing Address - Street 1:1735 SLATER AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4042
Mailing Address - Country:US
Mailing Address - Phone:910-488-4584
Mailing Address - Fax:910-630-3169
Practice Address - Street 1:3274 ROSEHILL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3018
Practice Address - Country:US
Practice Address - Phone:910-488-5820
Practice Address - Fax:910-488-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3409677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty