Provider Demographics
NPI:1881735256
Name:CEIBA COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:CEIBA COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CCS, LCAS
Authorized Official - Phone:919-844-6348
Mailing Address - Street 1:3509 HAWORTH DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7238
Mailing Address - Country:US
Mailing Address - Phone:919-873-1551
Mailing Address - Fax:919-873-1512
Practice Address - Street 1:3509 HAWORTH DR
Practice Address - Street 2:SUITE 304
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7238
Practice Address - Country:US
Practice Address - Phone:919-844-6348
Practice Address - Fax:919-844-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005447Medicaid