Provider Demographics
NPI:1801901129
Name:CASCADE BEHAVIORAL TREATMENT SERVICES, INC
Entity type:Organization
Organization Name:CASCADE BEHAVIORAL TREATMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LCAS
Authorized Official - Phone:252-758-2065
Mailing Address - Street 1:PO BOX 8344
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8344
Mailing Address - Country:US
Mailing Address - Phone:252-758-2065
Mailing Address - Fax:252-758-2084
Practice Address - Street 1:325 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5005
Practice Address - Country:US
Practice Address - Phone:252-758-2065
Practice Address - Fax:252-758-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-074-155251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005919Medicaid
NC8300208Medicaid
NC6604056Medicaid