Provider Demographics
NPI:1932570488
Name:CARDINAL DIRECTIONS BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:CARDINAL DIRECTIONS BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PHD-ABD, LCASA
Authorized Official - Phone:919-917-0609
Mailing Address - Street 1:1300 TRIBUTE CENTER DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3214
Mailing Address - Country:US
Mailing Address - Phone:919-917-3488
Mailing Address - Fax:
Practice Address - Street 1:1300 TRIBUTE CENTER DR
Practice Address - Street 2:SUITE 135
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3214
Practice Address - Country:US
Practice Address - Phone:919-917-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-3115251S00000X
NC1043564271305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1043564271Medicaid