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Organization
ROBESON HEALTH CARE CORPORATION
Active
Organization
ROBESON HEALTH CARE CORPORATION
Active
Other names
Crystal Lake
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM HALL M.DIV. (VP/CHIEF OF BEHAVIORAL HEALTH SVCS)
(910) 521-2900
Entity
Organization
Contact information
Practice address
285 CAMP EASTER RD, LAKEVIEW, NC 28350-1901
(910) 245-4339
(910) 245-4799
Mailing address
60 COMMERCE DRIVE, PEMBROKE, NC 28372
(910) 521-2900
(910) 272-1654
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
MHL-063-055
NC
251S00000X
Community/Behavioral Health Agency
Primary
MHL-063-055
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005787
—
NC
05
—
8300803
—
NC
05
—
8300803B
—
NC
05
—
8300803G
—
NC
05
—
8300803P
—
NC
05
—
8300803Q
—
NC
Enumeration date
02/13/2007
Last updated
06/28/2017
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