Cardinal Clinic L.L.C.

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

CARDINAL CLINIC L.L.C.

Practice address

1540 Purdue Dr Ste 200
Fayetteville, NC 28303-5510

Phone

(910) 867-8889

Fax

(910) 487-3061

NPI assigned

Oct 18, 2006

Last updated

May 20, 2009By 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

Tony Garcia

Title

QM Coordinator

Phone

(910) 864-0187

Specialties & licenses 9

Addresses

Other identifiers 2

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242777600000",
    "number": "1700967395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 PURDUE DR STE 200",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035510",
            "telephone_number": "910-867-8889",
            "fax_number": "910-487-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 PURDUE DR STE 200",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035510",
            "telephone_number": "910-867-8889",
            "fax_number": "910-487-3061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDINAL CLINIC L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2009-05-20",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "QM COORDINATOR",
        "authorized_official_telephone_number": "910-864-0187"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005134",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005172",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Capitolo, LCMHCA
• Marissa Capps
• Ganouse Capricien-Souffrant, RN
• Janet Cardassi, MA, LPA, LCAS
• Maranda Carden
• Cardinal Clinic LLC
• Cardinal Clinic LLC
• Cardinal Clinic, LLC
• Cardinal Clinic, LLC
• Cardinal Headache Center

• Counselor in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2009; 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.