NPIMap

Organization Active NPI

Community Connections Healthcare Services, LLC

  • Addiction Psychiatry Physician
  • Fayetteville, NC
National Provider Identifier
1902124191
Registry record updated Apr 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Psychiatry PhysicianTaxonomy code 2084P0802X
License
127550 Issued in NC
Legal business name
COMMUNITY CONNECTIONS HEALTHCARE SERVICES, LLC
Practice address
690 N Reilly Rd
Fayetteville, NC 28303-5724
Phone
(910) 879-6102
Fax
(919) 544-1661
NPI assigned
May 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2013

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

Authorized official

Name
Ms. Allesha McKoy
Title
Executive Director
Phone
(910) 879-6102

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Addiction Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0802X 127550 NC Primary

Addresses

Primary practice location

690 N Reilly Rd
Fayetteville, NC 28303-5724

Mailing address

282 W Millbrook Rd
Suite 100
Raleigh, NC 27609-4676
Phone (919) 665-4673

Other identifiers 2

IdentifierTypeStateIssuer
5914232MedicaidNC
5914731MedicaidNC

National Provider Directory

National Provider Directory

Locations

282 W Millbrook Rd
Ste 100
Raleigh, NC 27609
Phone (919) 665-4673

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367280000000",
    "number": "1902124191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "282 W MILLBROOK RD",
            "address_2": "SUITE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276094676",
            "telephone_number": "919-665-4673",
            "fax_number": "919-544-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 N REILLY RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035724",
            "telephone_number": "910-879-6102",
            "fax_number": "919-544-1661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CONNECTIONS HEALTHCARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-12",
        "last_updated": "2013-04-30",
        "status": "A",
        "authorized_official_last_name": "MCKOY",
        "authorized_official_first_name": "ALLESHA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-879-6102",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NC",
            "license": "127550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5914232",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5914731",
            "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 Apr 30, 2013; 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.