Provisions Behavioral Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROVISIONS BEHAVIORAL SERVICES

Practice address

1504 Gillespie St
Fayetteville, NC 28306-1846

Phone

(910) 308-8366

Fax

(910) 424-3453

NPI assigned

May 17, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Jannetta Delois Jordan, PH.D.

Title

Ceo

Phone

(910) 308-8366

Specialties & licenses 1

Addresses

Other names 1

• Provisions Community Support Services, LLC Doing business as

Locations

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

{
    "created_epoch": "1242518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246924800000",
    "number": "1780819003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 GILLESPIE ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283061846",
            "telephone_number": "910-308-8366",
            "fax_number": "910-424-3453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 GILLESPIE ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283061846",
            "telephone_number": "910-308-8366",
            "fax_number": "910-424-3453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISIONS BEHAVIORAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-17",
        "last_updated": "2009-07-07",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "JANNETTA",
        "authorized_official_middle_name": "DELOIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-308-8366",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provisions Community Support Services, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.