Provider Demographics
NPI:1801917968
Name:CUMBERLAND COUNTY COMMUNICARE, INC.
Entity type:Organization
Organization Name:CUMBERLAND COUNTY COMMUNICARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:HEMINGWAY
Authorized Official - Last Name:HALLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-222-6089
Mailing Address - Street 1:P.O. BOX 87830
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7830
Mailing Address - Country:US
Mailing Address - Phone:910-829-9017
Mailing Address - Fax:910-485-4752
Practice Address - Street 1:226 BRADFORD AVE.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5404
Practice Address - Country:US
Practice Address - Phone:910-829-9017
Practice Address - Fax:910-485-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-821251S00000X
NC026-821101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301516Medicaid
NC6005914Medicaid