Professional Early Intervention Services, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PROFESSIONAL EARLY INTERVENTION SERVICES, LLC

Practice address

1708A Owen Dr
Fayetteville, NC 28304-3419

Phone

(910) 425-6282

Fax

(910) 425-6554

NPI assigned

Oct 23, 2006

Last updated

Apr 1, 2022By the provider in NPPES

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.EDNPI 1346564309

Title

Owner

Phone

(910) 425-6282

Specialties & licenses 11

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

  • Multi-Specialty Clinic/Center
  • Fayetteville, NC
  • NPI 1285775866
  NPD tax ID
• Professional Early Intervention Services, LLC

  • Behavior Analyst
  • Raeford, NC
  • NPI 1295679561
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cynthia M Carroll, ITFS, M.ED

  • Behavior Analyst
  • Fayetteville, NC
  • NPI 1346564309
  Authorized official Same address or phone
• 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": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648771200000",
    "number": "1629151832",
    "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": "1708A OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043419",
            "telephone_number": "910-425-6282",
            "fax_number": "910-425-6554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2722 Fort Bragg Rd",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283034721",
            "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": "2006-10-23",
        "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": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_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": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.