Provider Demographics
NPI:1962848291
Name:BEHAVIORAL COUNSELING & PSYCHOLOGICAL SVC, PA
Entity Type:Organization
Organization Name:BEHAVIORAL COUNSELING & PSYCHOLOGICAL SVC, PA
Other - Org Name:THE DWI CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:O
Authorized Official - Last Name:CARDASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-485-1703
Mailing Address - Street 1:916 HAY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5314
Mailing Address - Country:US
Mailing Address - Phone:910-485-1703
Mailing Address - Fax:910-435-0962
Practice Address - Street 1:916 HAY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5314
Practice Address - Country:US
Practice Address - Phone:910-485-1703
Practice Address - Fax:910-435-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-887251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303471QMedicaid