| Csp Diagnostic Assessment | |
|
1606 Wellington Ave Unit C Wilmington NC 28401-7704 | |
| (910) 799-4505 | |
| (910) 799-4345 |
| Full Name | Csp Diagnostic Assessment |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1606 Wellington Ave Unit C, Wilmington, North Carolina |
| Authorized Official Name and Position | Martin P. Justafort (OPERATIONS MANAGER) |
| Authorized Official Contact | 9107994505 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Csp Diagnostic Assessment 1606 Wellington Ave Unit C Wilmington NC 28401-7704 Ph: (910) 799-4505 | Csp Diagnostic Assessment 1606 Wellington Ave Unit C Wilmington NC 28401-7704 Ph: (910) 799-4505 |
| NPI Number | 1265761092 |
|---|---|
| Provider Enumeration Date | 12/07/2009 |
| Last Update Date | 12/07/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265761092 | NPI | - | NPPES |
| 8300728G | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 8300728G (North Carolina) | Primary |
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