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Organization
PINE VILLAGE TREATMENT SERVICES
Active
Organization
PINE VILLAGE TREATMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS A DEREPENTIGNY (OWNER)
(910) 864-7004
Entity
Organization
Contact information
Practice address
1206 HOPE MILLS RD, FAYETTEVILLE, NC 28304-4215
(910) 864-7004
(910) 864-3002
Mailing address
1206 HOPE MILLS RD, FAYETTEVILLE, NC 28304-4215
(910) 864-7004
(910) 864-3002
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-047-096
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301247
—
NC
Enumeration date
08/20/2006
Last updated
10/01/2008
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