Organization
CMC-NORTHEAST, INC.
Active
Parent organization
CMC-NORTHEAST, INC.
Other names
NorthEast Psychiatric Services - Albemarle
Organization subpart
Yes
Provider details
NPI number
Legal business name
CMC-NORTHEAST, INC.
Authorized official
FRIEDA M LOWDER (VP PHYSICIAN SERVICES)
(704) 403-4146
Entity
Organization
Contact information
Practice address
105 YADKIN STREET, SUITE 302, ALBEMARLE, NC 28001-3454
(704) 403-1877
(704) 986-2150
Mailing address
105 YADKIN STREET, SUITE 302, ALBEMARLE, NC 28001-3454
(704) 403-1877
(704) 986-2150
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019G5
BCBSNC
NC
01
—
355573
MAMSI
NC
01
—
566000156058
TRICARE STANDARD, NON NWK
NC
05
—
5906956
—
NC
05
—
6005328
—
NC
01
—
6006579
MEDICAID, EFF 10/27/2008
NC
05
—
89015E5
—
NC
01
—
B948
PARTNERS MEDICARE CHOICE
NC
01
—
CC2854
RAILROAD MEDICARE
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
Enumeration date
01/19/2007
Last updated
06/01/2012
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