NPIMap

Organization Active NPI

Pine Village Treatment Services Inc

  • Mental Health Counselor
  • Clayton, NC
National Provider Identifier
1013182286
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PINE VILLAGE TREATMENT SERVICES INC
Practice address
106 S Lombard St
Clayton, NC 27520-2527
Phone
(919) 550-7645
Fax
(919) 550-7754
NPI assigned
Apr 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Chris A Derepentigny
Title
Owner
Phone
(910) 864-7004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

106 S Lombard St
Clayton, NC 27520-2527

Mailing address

106 S Lombard St
Clayton, NC 27520-2527
Phone (919) 550-7645

Other identifiers 1

IdentifierTypeStateIssuer
6006309MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Pine Village Treatment Services Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1013182286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 S LOMBARD ST",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275202527",
            "telephone_number": "919-550-7645",
            "fax_number": "919-550-7754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 S LOMBARD ST",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275202527",
            "telephone_number": "919-550-7645",
            "fax_number": "919-550-7754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE VILLAGE TREATMENT SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "DEREPENTIGNY",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-864-7004",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006309",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.