| Cumberland Behavioral Care | |
|
2931 Breezewood Ave Ste 104 Fayetteville NC 28303-5281 | |
| (910) 491-1134 | |
| (910) 491-1332 |
| Full Name | Cumberland Behavioral Care |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2931 Breezewood Ave Ste 104, Fayetteville, North Carolina |
| Authorized Official Name and Position | Robert Christopher Pennebaker (PRESIDENT) |
| Authorized Official Contact | 9109771396 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cumberland Behavioral Care 5774 Waters Edge Dr Fayetteville NC 28314-1055 Ph: (910) 977-1396 | Cumberland Behavioral Care 2931 Breezewood Ave Ste 104 Fayetteville NC 28303-5281 Ph: (910) 491-1134 |
| NPI Number | 1144657677 |
|---|---|
| Provider Enumeration Date | 09/30/2013 |
| Last Update Date | 11/30/2020 |
| Certification Date | 11/30/2020 |
| Medicare PECOS PAC ID | 3870802010 |
|---|---|
| Medicare Enrollment ID | O20151029000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144657677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C002032 (North Carolina) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 5005524 (North Carolina) | Primary |
| Provider Name | Robert C Pennebaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609957505 PECOS PAC ID: 2567637184 Enrollment ID: I20151029000414 |
| Provider Name | Ashley G Clocher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891121372 PECOS PAC ID: 3173833902 Enrollment ID: I20151107000128 |
| Provider Name | Sue E Hunt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932507159 PECOS PAC ID: 2062848922 Enrollment ID: I20200212002567 |
| Provider Name | Danyelle Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184336893 PECOS PAC ID: 0840664991 Enrollment ID: I20230817003272 |
| Provider Name | Tyra Oxendine |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700493228 PECOS PAC ID: 8729430616 Enrollment ID: I20240116003330 |
| Provider Name | Denise Downing Holmes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336321298 PECOS PAC ID: 7113366048 Enrollment ID: I20240411002941 |
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