Organization
COUNTY OF CUMBERLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENSIE D LUCAS (ASSISTANT AREA DIRECTOR)
(910) 323-0601
Entity
Organization
Contact information
Practice address
1724 ROXIE AVE, FAYETTEVILLE, NC 28304-1623
(910) 323-0601
(910) 323-0096
Mailing address
PO BOX 3069, FAYETTEVILLE, NC 28302-3069
(910) 323-0601
(910) 323-0096
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-026-107
NC
324500000X
Substance Abuse Rehabilitation Facility
MHL-026-107
NC
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5901594
PHYSICIAN GROUP NUMBER
NC
01
—
6005769
MULTI-SPECIALTY GROUP MUN
NC
Enumeration date
03/07/2007
Last updated
01/16/2008
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