Professional Early Intervention Services, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PROFESSIONAL EARLY INTERVENTION SERVICES, LLC

Practice address

2722 Fort Bragg Rd
Fayetteville, NC 28303-4721

Phone

(910) 425-6282

Fax

(910) 425-6554

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Cynthia M Carroll, M.ED

Title

Owner

Phone

(910) 425-6282

Specialties & licenses 8

Addresses

Tax ID family

Professional Early Intervention Services LLC4 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.

• Professional Early Intervention Services, LLC

  • Community/Behavioral Health Agency
  • Garner, NC
  • NPI 1184455412
  NPD tax ID
• Professional Early Intervention Services, LLC

  • Behavior Analyst
  • Raeford, NC
  • NPI 1295679561
  NPD tax ID
• Professional Early Intervention Services, LLC

  • Multi-Specialty Clinic/Center
  • Fayetteville, NC
  • NPI 1629151832
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michele Welker Gilbreath, OTR/L

  • Occupational Therapist
  • Fayetteville, NC
  • NPI 1225223027
  NPD (past)
• Lacey J Gutierrez, M.S., RBT, ITFS

  • Behavior Analyst
  • Fayetteville, NC
  • NPI 1427421247
  NPD (past)
• Elyse L. Roach, MA/CCC-SLP

  • Speech-Language Pathologist
  • Fayetteville, NC
  • NPI 1831459932
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648771200000",
    "number": "1285775866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708A OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043419",
            "telephone_number": "910-425-6282",
            "fax_number": "910-425-6554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2722 FORT BRAGG RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283034721",
            "telephone_number": "910-425-6282",
            "fax_number": "910-425-6554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1708A Owen Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043419",
            "country_code": "US",
            "telephone_number": "910-425-6282",
            "fax_number": "910-425-6554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROFESSIONAL EARLY INTERVENTION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-425-6282",
        "authorized_official_credential": "M.ED"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harrison Wade Pritchard
• Private Diagnostic Clinic, PLLC (Duke Children's Cardiology of Fayetteville)
• Proactive MD NC, PC (Proactive MD Cumberland County Employee Health Center)
• Professional Anesthesia Services
• Professional Care Services, Inc.
• Professional Early Intervention Services, LLC
• Professional Family Care Services, Inc
• Professional Family Care Services, Inc
• Professional Family Care Services, Inc
• Professional Family Care Services, Inc.

• Multi-Specialty Clinic/Center in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Multi-Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; 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.