Organization Active NPI

Cape Fear Behavioral Health Center LLC

  • Addiction (Substance Use Disorder) Counselor
  • Fayetteville, NC
National Provider Identifier
1790062057
Registry record updated Oct 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
CAPE FEAR BEHAVIORAL HEALTH CENTER LLC
Practice address
6885 Cliffdale Rd Ste 202
Fayetteville, NC 28314-2834
Phone
(910) 339-0400
Fax
(910) 339-0396
NPI assigned
Nov 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2014

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

Authorized official

Name
Dr. Angela Elizabeth Kidd
Title
Member/Manager
Phone
(910) 339-0400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X

Addresses

Primary practice location

6885 Cliffdale Rd Ste 202
Fayetteville, NC 28314-2834

Mailing address

6885 Cliffdale Rd Ste 202
Fayetteville, NC 28314-2834
Phone (910) 339-0400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260501000375 NC Part B Supplier - Clinic/Group Practice 2860969458 Receives reassigned benefits from 1 practitioner
Practice locations: Fayetteville, NC

National Provider Directory

National Provider Directory

Locations

6885 Cliffdale Rd
Ste 202
Fayetteville, NC 28314
Phone (910) 339-0393

Practitioners & affiliated clinicians

Practitioners 62

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

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1790062057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6885 CLIFFDALE RD STE 202",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283142834",
            "telephone_number": "910-339-0400",
            "fax_number": "910-339-0396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6885 CLIFFDALE RD STE 202",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283142834",
            "telephone_number": "910-339-0400",
            "fax_number": "910-339-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPE FEAR BEHAVIORAL HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2014-10-03",
        "status": "A",
        "authorized_official_last_name": "KIDD",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "910-339-0400",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Oct 3, 2014; 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.