Provider Demographics
NPI:1932832557
Name:REBOOT BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:REBOOT BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:910-305-8893
Mailing Address - Street 1:5917 FUCHSIA CT
Mailing Address - Street 2:
Mailing Address - City:STEDMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28391-3401
Mailing Address - Country:US
Mailing Address - Phone:910-305-8893
Mailing Address - Fax:
Practice Address - Street 1:3011 TOWN CENTER DR
Practice Address - Street 2:STE 130 UNIT #122
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306
Practice Address - Country:US
Practice Address - Phone:910-727-4590
Practice Address - Fax:910-407-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty