Provider Demographics
NPI: | 1760808422 |
---|---|
Name: | ARRAY OF BRIGHTER BEGINNINGS INC |
Entity Type: | Organization |
Organization Name: | ARRAY OF BRIGHTER BEGINNINGS INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE OFFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CARLOS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WEBB |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 704-215-6896 |
Mailing Address - Street 1: | 813 S OAKLAND ST STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | GASTONIA |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28054-0474 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-215-6896 |
Mailing Address - Fax: | 704-671-2694 |
Practice Address - Street 1: | 813 S OAKLAND ST STE A |
Practice Address - Street 2: | |
Practice Address - City: | GASTONIA |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28054-0474 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-215-6896 |
Practice Address - Fax: | 704-671-2694 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-03-05 |
Last Update Date: | 2019-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |
No | 1041S0200X | Behavioral Health & Social Service Providers | Social Worker | School | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 172A00000X | Other Service Providers | Driver | Group - Multi-Specialty | |
No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | NPB762 | Medicaid | |
NC | 60054 | Other | AETNA |
NC | 176080 | Medicaid | |
SC | 60054 | Other | AETNA |