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Organization

COMMUNITY INNOVATIONS, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ANDY ANDERSON (PRESIDENT CEO)
(910) 739-8849
Entity
Organization

Contact information

Practice address
2003 GODWIN AVE, SUITE A, LUMBERTON, NC 28358-3197
(910) 739-8849
(910) 739-5167
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3215
(919) 256-0824
(919) 256-0833

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5903155
NC
Enumeration date
03/07/2007
Last updated
04/29/2009
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