| Pine Village Treatment Services, Inc. | |
|
1206 Hope Mills Rd Fayetteville NC 28304-4215 | |
| (910) 864-7004 | |
| (910) 864-3002 |
| Full Name | Pine Village Treatment Services, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1206 Hope Mills Rd, Fayetteville, 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. 1206 Hope Mills Rd Fayetteville NC 28304-4215 Ph: (910) 864-7004 | Pine Village Treatment Services, Inc. 1206 Hope Mills Rd Fayetteville NC 28304-4215 Ph: (910) 864-7004 |
| NPI Number | 1528232915 |
|---|---|
| Provider Enumeration Date | 04/16/2008 |
| Last Update Date | 10/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528232915 | NPI | - | NPPES |
| 6006308 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MHL-047-096 (North Carolina) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
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