CARDINAL CLINIC LLC (NPI# 1982761250) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982761250 |
| Entity Type | Organization |
| Organization Name | CARDINAL CLINIC LLC |
| Practice Address |
1540 Purdue Dr Ste 200 Fayetteville NC 28303-5510 |
| Practice Telephone | 9108678889 |
| Mailing Telephone | 9108678889 |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2009-05-20 |
| Authorized Official Name | TONY GARCIA (QM COORDINATOR) |
| Authorized Official Telephone | 9108640187 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 8300391 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275690042 | Cardinal Clinic LLC | Counselor | 704b Progress Place, Laurinburg, NC 28352-5545 | 2007-01-02 |
| 1689757809 | Cardinal Clinic LLC | Community Based Residential Treatment Facility, Mental Illness | 841 Circlewood Dr, Hamlet, NC 28345-4529 | 2006-10-23 |
| 1609925668 | Cardinal Clinic LLC | Counselor | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-01-09 |
| 1932263720 | Cardinal Clinic LLC | Community/Behavioral Health | 160 Pinehurst Ave Ste J, Southern Pines, NC 28387-7078 | 2006-12-19 |
| Street Address |
1540 PURDUE DR STE 200 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28303-5510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053339283 | Deitra Letrice Williams-toone | Anesthesiology | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2006-07-17 |
| 1194225490 | Caroline Miller Harris | Physical Medicine & Rehabilitation | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2018-02-14 |
| 1437373578 | Cardinal Clinic, LLC | Psychiatry & Neurology | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-04-12 |
| 1023156932 | Theodore W. Lane | Psychologist | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-02-02 |
| 1659419430 | Aaron Melvin | Social Worker | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-02-02 |
| 1609925668 | Cardinal Clinic LLC | Counselor | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-01-09 |
| 1700967395 | Cardinal Clinic L.L.C. | Counselor | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2006-10-18 |
| 1679653588 | Brenda M. Dixon | Counselor | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2006-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801404496 | Matthew Pace | Physician Assistant | Bldg 5-4257 Bastogne St, Fort Bragg, NC 28303 | 2020-07-20 |
| 1952920449 | Vonetta Bethea Jackson | Social Worker | 391 Wagoner Drive, Fayetteville, NC 28303 | 2020-04-14 |
| 1932746229 | Julie Harriss | Specialist/Technologist | Bldg E 4062, Canopy Lane, Fort Bragg, NC 28303 | 2019-12-05 |
| 1235780354 | Helen Delores Johnson | Technician | 261 Pierron Dr, Fayetteville, NC 28303 | 2019-09-20 |
| 1922655075 | Andrea Margaret Hutnam | Technician | 714 Shortridge Rd, Fayetteville, NC 28303 | 2019-08-23 |
| 1225695273 | Breona Lister | Dental Hygienist | 38 17 Gruber Rd, Fort Bragg, NC 28303 | 2019-05-24 |
| 1780148957 | Brian K Cox Sr. | Occupational Therapy Assistant | 5300 Ramsey St, Fayetteville, NC 28303 | 2019-01-22 |
| 1730670902 | Michael Sadtler | Counselor | 804 Stamper Rd Ste 101, Fayetteville, NC 28303 | 2018-05-23 |
| 1104320399 | Tia Porterfield | Counselor | 2018 Fort Bragg Rd Ste 112a, Fayetteville, NC 28303 | 2018-03-21 |
| 1154835577 | Jessica Bass Bosworth | Psychologist | 3415 Youngstown Dr, Fayetteville, NC 28303 | 2017-11-21 |
| Find all providers in zip 28303 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528696796 | Faith Springs Eternal (fase), Pllc | Community/Behavioral Health | 2537 Gray Goose Loop, Fayetteville, NC 28306-3550 | 2020-04-01 |
| 1134684392 | Carolina Outreach, LLC | Community/Behavioral Health | 324 Person St, Fayetteville, NC 28301-5736 | 2019-02-01 |
| 1124591094 | Changing Places Therapeutic Center, Company | Community/Behavioral Health | 1044 Bragg Blvd Ste B, Fayetteville, NC 28301-4512 | 2019-01-03 |
| 1538632518 | Benevolent Counseling, Pllc | Community/Behavioral Health | 2929 Breezewood Ave Ste 203, Fayetteville, NC 28303-5357 | 2019-01-02 |
| 1386128031 | Alexander Youth Network | Community/Behavioral Health | 2115 Hope Mills Rd, Fayetteville, NC 28304-4256 | 2018-09-19 |
| 1811497639 | Alexander Youth Network | Community/Behavioral Health | 1608 Camden Rd, Rooms #16 & #17, Fayetteville, NC 28306-1734 | 2018-02-19 |
| 1629578851 | Jeanette Bostick | Community/Behavioral Health | 1628 Turkey Run, Fayetteville, NC 28312-7643 | 2018-02-14 |
| 1942718325 | A Mother's Pursuit, LLC | Community/Behavioral Health | 511 N Reilly Rd Ste A, Fayetteville, NC 28303-2440 | 2018-01-18 |
| 1992213771 | Deborah A Atkinson Phd Pllc | Community/Behavioral Health | 501 Executive Pl Ste B, Fayetteville, NC 28305-5391 | 2018-01-16 |
| 1841739455 | Aci Support Specialists | Community/Behavioral Health | 414 Snowhill Rd, Fayetteville, NC 28306-9073 | 2017-02-15 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28303 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.