| Clinicaladdictionprofessionalservices | |
|
3925 N.dukest.suite123 Durham NC 27704-1780 | |
| (919) 680-8833 | |
| (919) 682-7496 |
| Full Name | Clinicaladdictionprofessionalservices |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3925 N.dukest.suite123, Durham, North Carolina |
| Authorized Official Name and Position | Stephen A Loney (OWNER/DIRECTOR) |
| Authorized Official Contact | 9196808833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinicaladdictionprofessionalservices 3925 N Duke St Ste 123 Durham NC 27704-1780 Ph: (919) 680-8833 | Clinicaladdictionprofessionalservices 3925 N.dukest.suite123 Durham NC 27704-1780 Ph: (919) 680-8833 |
| NPI Number | 1770910762 |
|---|---|
| Provider Enumeration Date | 10/04/2013 |
| Last Update Date | 11/19/2021 |
| Certification Date | 11/19/2021 |
| Medicare PECOS PAC ID | 3678900305 |
|---|---|
| Medicare Enrollment ID | O20200826001896 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770910762 | NPI | - | NPPES |
| 6006617 | Medicaid | NC |
| Provider Name | Hattie D Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164759239 PECOS PAC ID: 2264859917 Enrollment ID: I20200826004036 |
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