NPIMap

Organization Active NPI

Children's Health of Carolina Dba Pembroke Pediatrics Mental Health

  • Mental Health Counselor
  • Lumberton, NC
National Provider Identifier
1679768303
Registry record updated Sep 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
CHILDREN'S HEALTH OF CAROLINA DBA PEMBROKE PEDIATRICS MENTAL HEALTH
Practice address
400 Liberty Hill Rd
Lumberton, NC 28358-2446
Phone
(910) 738-8060
Fax
(910) 671-3600
NPI assigned
Sep 6, 2007
Last updated
Sep 6, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDREN'S HEALTH OF CAROLINAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 6, 2007

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

Authorized official

Name
Rose Duckworth
Title
Compliance Officer
Phone
(910) 738-8060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

400 Liberty Hill Rd
Lumberton, NC 28358-2446

Mailing address

812 Candy Park Rd
Pembroke, NC 28372-9129
Phone (910) 521-0201

Other identifiers 1

IdentifierTypeStateIssuer
890253UMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Children's Health of Carolina Dba Pembroke Pediatrics Mental Health9 organizations share this tax ID, including this one
Part of
Children's Health of Carolina Dba Pembroke Pediatrics Mental Health

Other organizations with this tax ID 8

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189036800000",
    "number": "1679768303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 CANDY PARK RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283729129",
            "telephone_number": "910-521-0201",
            "fax_number": "910-521-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 LIBERTY HILL RD",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283582446",
            "telephone_number": "910-738-8060",
            "fax_number": "910-671-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S HEALTH OF CAROLINA DBA PEMBROKE PEDIATRICS MENTAL HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S HEALTH OF CAROLINA",
        "enumeration_date": "2007-09-06",
        "last_updated": "2007-09-06",
        "status": "A",
        "authorized_official_last_name": "DUCKWORTH",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "910-738-8060"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890253U",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lumberton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2007; 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.