Provider Demographics
NPI:1851524193
Name:STANDING IN THE GAP OF NORTH CAROLINA, LLC
Entity Type:Organization
Organization Name:STANDING IN THE GAP OF NORTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-797-3522
Mailing Address - Street 1:1014 HAY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5316
Mailing Address - Country:US
Mailing Address - Phone:910-321-1662
Mailing Address - Fax:910-321-1664
Practice Address - Street 1:1014 HAY STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5316
Practice Address - Country:US
Practice Address - Phone:910-797-3522
Practice Address - Fax:910-488-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management