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Organization
PROVISIONS BEHAVIORAL SERVICES
Active
Organization
PROVISIONS BEHAVIORAL SERVICES
Active
Other names
Provisions Community Support Services, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JANNETTA DELOIS JORDAN PH.D. (CEO)
(910) 308-8366
Entity
Organization
Contact information
Practice address
1504 GILLESPIE ST, FAYETTEVILLE, NC 28306-1846
(910) 308-8366
(910) 424-3453
Mailing address
1504 GILLESPIE ST, FAYETTEVILLE, NC 28306-1846
(910) 308-8366
(910) 424-3453
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/17/2009
Last updated
07/07/2009
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