NPIMap

Life Changing Behavioral Health Services

Organization Active NPI Psychiatry Physician · Fairmont, NC

NPI 1811208747 · NPPES record last updated Jun 25, 2010

Key facts

NPI
1811208747
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
LIFE CHANGING BEHAVIORAL HEALTH SERVICES
Practice address
314 S Main St
Fairmont, NC 28340-1906
Phone
(910) 628-6476
Fax
(910) 628-6531
NPI assigned
Jun 25, 2010
Organization subpart
No

Authorized official

Name
Mr. Luis Roman
Title
Coo
Phone
(910) 770-2682

Corporate family (same tax ID) 11

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

National Provider Directory

Tax ID family
Life Changing Behavioral Health Services (12 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychosomatic Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0015X
Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0800X Yes
Addiction Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0802X
Child & Adolescent Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0804X
Pain Medicine (Psychiatry & Neurology) Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P2900X

Addresses

Primary practice location

314 S Main St
Fairmont, NC 28340-1906

Mailing address

314 S Main St
Fairmont, NC 28340-1906
Phone (910) 628-6476

Other providers in Fairmont, NC

All providers in Fairmont, NC · Psychiatry Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.