Active NPI
County of Cumberland
- Psychiatry Physician
- Fayetteville, NC
National Provider Identifier
1750412516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- Legal business name
- COUNTY OF CUMBERLAND
- Practice address
- 1724 Roxie Ave
Fayetteville, NC 28304-1623 - Phone
- (910) 323-0601
- Fax
- (910) 323-0096
- NPI assigned
- Mar 7, 2007
- Last updated
- Jan 16, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Densie D Lucas
- Title
- Assistant Area Director
- Phone
- (910) 323-0601
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | MHL-026-107 | NC | |
| Substance Abuse Rehabilitation Facility | 324500000X | MHL-026-107 | NC | |
| Respite Care | 385H00000X | |||
| Psychiatry Physician | 2084P0800X | Primary | ||
| Child & Adolescent Psychiatry Physician | 2084P0804X |
Addresses
Primary practice location
1724 Roxie Ave
Fayetteville, NC 28304-1623
Mailing address
PO Box 3069
Fayetteville, NC 28302-3069
Phone (910) 323-0601
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5901594 | Other | NC | PHYSICIAN GROUP NUMBER |
| 6005769 | Other | NC | MULTI-SPECIALTY GROUP MUN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040511001437 | NC | Part B Supplier - Clinic/Group Practice | 8921097163 |
Receives reassigned benefits from 5 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fayetteville, NC |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Addiction (Substance Use Disorder) Counselor
- Fayetteville, NC
- NPI 1558491381
O20040511001437
-
- Public Health or Welfare Agency
- Fayetteville, NC
- NPI 1831249986
O20040511001437
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1200441600000",
"number": "1750412516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3069",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283023069",
"telephone_number": "910-323-0601",
"fax_number": "910-323-0096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1724 ROXIE AVE",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283041623",
"telephone_number": "910-323-0601",
"fax_number": "910-323-0096"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF CUMBERLAND",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-07",
"last_updated": "2008-01-16",
"status": "A",
"authorized_official_last_name": "LUCAS",
"authorized_official_first_name": "DENSIE",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "ASSISTANT AREA DIRECTOR",
"authorized_official_telephone_number": "910-323-0601",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "NC",
"license": "MHL-026-107",
"primary": false
},
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": "NC",
"license": "MHL-026-107",
"primary": false
},
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN GROUP NUMBER",
"identifier": "5901594",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTI-SPECIALTY GROUP MUN",
"identifier": "6005769",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; 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.