Provider Demographics
NPI:1649455767
Name:ASSOCIATE BEHAVIORAL SERVICE
Entity type:Organization
Organization Name:ASSOCIATE BEHAVIORAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-735-0556
Mailing Address - Street 1:206 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-4882
Mailing Address - Country:US
Mailing Address - Phone:910-735-0556
Mailing Address - Fax:910-739-7877
Practice Address - Street 1:206 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-4882
Practice Address - Country:US
Practice Address - Phone:910-735-0556
Practice Address - Fax:910-739-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300308GMedicaid