Organization
CARDINAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY GARCIA (QM COORDINATOR)
(910) 864-0187
Entity
Organization
Contact information
Practice address
1540 PURDUE DR STE 200, FAYETTEVILLE, NC 28303-5510
(910) 867-8889
Mailing address
1540 PURDUE DR STE 200, FAYETTEVILLE, NC 28303-5510
(910) 867-8889
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300391
—
NC
Enumeration date
01/03/2007
Last updated
05/20/2009
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