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Organization
CARDINAL CLINIC L.L.C.
Active
Organization
CARDINAL CLINIC L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY GARCIA (QM COORDINATOR)
(910) 864-0187
Entity
Organization
Contact information
Practice address
1540 PURDUE DR STE 200, FAYETTEVILLE, NC 28303-5510
(910) 867-8889
(910) 487-3061
Mailing address
1540 PURDUE DR STE 200, FAYETTEVILLE, NC 28303-5510
(910) 867-8889
(910) 487-3061
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005134
—
NC
05
—
6005172
—
NC
Enumeration date
10/18/2006
Last updated
05/20/2009
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