| Pine Village Treatment Services Inc | |
|
106 S Lombard St Clayton NC 27520-2527 | |
| (919) 550-7645 | |
| (919) 550-7754 |
| Full Name | Pine Village Treatment Services Inc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 106 S Lombard St, Clayton, North Carolina |
| Authorized Official Name and Position | Chris A Derepentigny (OWNER) |
| Authorized Official Contact | 9108647004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Village Treatment Services Inc 106 S Lombard St Clayton NC 27520-2527 Ph: (919) 550-7645 | Pine Village Treatment Services Inc 106 S Lombard St Clayton NC 27520-2527 Ph: (919) 550-7645 |
| NPI Number | 1013182286 |
|---|---|
| Provider Enumeration Date | 04/28/2008 |
| Last Update Date | 10/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013182286 | NPI | - | NPPES |
| 6006309 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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