MBS Restorative Centre PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MBS RESTORATIVE CENTRE PLLC

Practice address

1140 Kildaire Farm Rd Ste 206
Cary, NC 27511-4597

Phone

(919) 633-9403

Fax

(919) 650-1218

NPI assigned

Mar 4, 2018

Organization subpart

No

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

Authorized official

Name

Delva Douglas, LCSWNPI 1902275324

Title

Owner

Phone

(919) 633-9403

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 6

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

• Delva Douglas, L.C.S.W.

  • Clinical Social Worker
  • Cary, NC
  • NPI 1902275324
  Medicare reassignment NPD Authorized official
• Renasha Santreanna Christmas, LCSWA

  • Clinical Social Worker
  • Cary, NC
  • NPI 1932677911
  NPD (past)
• Erin Michelle Graves, MS, LCAS

  • Addiction (Substance Use Disorder) Counselor
  • Cary, NC
  • NPI 1184959694
  NPD (past)
• Susan Hazel Ongombe

  • Mental Health Counselor
  • Cary, NC
  • NPI 1669059150
  NPD (past)
• Jennifer Tisdale

  • Social Worker
  • Garner, NC
  • NPI 1700443843

  Single Specialty

  NPD (past)
• Ebony Ragine Williamston, LCSW-A

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1326504689
  NPD (past)

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

{
    "created_epoch": "1520121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536710400000",
    "number": "1679075824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 KILDAIRE FARM RD STE 206",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275114597",
            "telephone_number": "919-633-1218",
            "fax_number": "919-650-1420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 KILDAIRE FARM RD STE 206",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275114597",
            "telephone_number": "919-633-9403",
            "fax_number": "919-650-1218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MBS RESTORATIVE CENTRE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-04",
        "last_updated": "2018-09-12",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "DELVA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-633-9403",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "102L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychoanalyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mya Alexis Mayweather
• Molly M Mazich, DPT
• Michael Lee Mazzella, PT
• Evan Mazzeo
• MBM Homecare, Inc.
• Robin Jean McAlister Mangione, M.D.
• Amy E McAlister, FNP
• Kristin Desiree McArthur, MD
• Reshauna McArthur
• Linda Marie McAteer, LMCMHCA, NCC

• Clinic/Center in Cary, NC
• Providers in Cary, NC by specialty
• Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.