Provider Demographics
NPI: | 1922328822 |
---|---|
Name: | CAROLINA BEHAVIORAL CARE |
Entity Type: | Organization |
Organization Name: | CAROLINA BEHAVIORAL CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | FLEURY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 910-295-6007 |
Mailing Address - Street 1: | 220 SMITH CHURCH RD |
Mailing Address - Street 2: | BUILDING C |
Mailing Address - City: | ROANOKE RAPIDS |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27870-4914 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-537-6619 |
Mailing Address - Fax: | 252-537-1540 |
Practice Address - Street 1: | 220 SMITH CHURCH RD |
Practice Address - Street 2: | BUILDING C |
Practice Address - City: | ROANOKE RAPIDS |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27870-4914 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-537-6619 |
Practice Address - Fax: | 252-537-1540 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-06-03 |
Last Update Date: | 2010-06-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |