Organization
COMMUNITY INNOVATIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDY ANDERSON (PRESIDENT)
(910) 642-5697
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 27612-3220
(919) 256-0824
(919) 256-8750
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005847
—
NC
Enumeration date
06/05/2007
Last updated
08/22/2020
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