CARDINAL CLINIC L.L.C. (NPI# 1700967395) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700967395 |
| Entity Type | Organization |
| Organization Name | CARDINAL CLINIC L.L.C. |
| Practice Address |
1540 Purdue Dr Ste 200 Fayetteville NC 28303-5510 |
| Practice Telephone | 9108678889 |
| Practice Fax Number | 9104873061 |
| Mailing Telephone | 9108678889 |
| Mailing Fax Number | 9104873061 |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2009-05-20 |
| Authorized Official Name | TONY GARCIA (QM COORDINATOR) |
| Authorized Official Telephone | 9108640187 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 106H00000X | Marriage & Family Therapist | Behavioral Health & Social Service Providers | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians | ||
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6005134 | 05 | |
| NC | 6005172 | 05 |
| Street Address |
1540 PURDUE DR STE 200 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28303-5510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053339283 | Deitra Letrice Williams-toone | Anesthesiology | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2006-07-17 |
| 1194225490 | Caroline Miller Harris | Physical Medicine & Rehabilitation | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2018-02-14 |
| 1437373578 | Cardinal Clinic, LLC | Psychiatry & Neurology | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-04-12 |
| 1023156932 | Theodore W. Lane | Psychologist | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-02-02 |
| 1659419430 | Aaron Melvin | Social Worker | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-02-02 |
| 1609925668 | Cardinal Clinic LLC | Counselor | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-01-09 |
| 1982761250 | Cardinal Clinic LLC | Counselor | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2007-01-03 |
| 1679653588 | Brenda M. Dixon | Counselor | 1540 Purdue Dr Ste 200, Fayetteville, NC 28303-5510 | 2006-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801404496 | Matthew Pace | Physician Assistant | Bldg 5-4257 Bastogne St, Fort Bragg, NC 28303 | 2020-07-20 |
| 1952920449 | Vonetta Bethea Jackson | Social Worker | 391 Wagoner Drive, Fayetteville, NC 28303 | 2020-04-14 |
| 1932746229 | Julie Harriss | Specialist/Technologist | Bldg E 4062, Canopy Lane, Fort Bragg, NC 28303 | 2019-12-05 |
| 1235780354 | Helen Delores Johnson | Technician | 261 Pierron Dr, Fayetteville, NC 28303 | 2019-09-20 |
| 1922655075 | Andrea Margaret Hutnam | Technician | 714 Shortridge Rd, Fayetteville, NC 28303 | 2019-08-23 |
| 1225695273 | Breona Lister | Dental Hygienist | 38 17 Gruber Rd, Fort Bragg, NC 28303 | 2019-05-24 |
| 1780148957 | Brian K Cox Sr. | Occupational Therapy Assistant | 5300 Ramsey St, Fayetteville, NC 28303 | 2019-01-22 |
| 1730670902 | Michael Sadtler | Counselor | 804 Stamper Rd Ste 101, Fayetteville, NC 28303 | 2018-05-23 |
| 1104320399 | Tia Porterfield | Counselor | 2018 Fort Bragg Rd Ste 112a, Fayetteville, NC 28303 | 2018-03-21 |
| 1154835577 | Jessica Bass Bosworth | Psychologist | 3415 Youngstown Dr, Fayetteville, NC 28303 | 2017-11-21 |
| Find all providers in zip 28303 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619576352 | Bianca Faith Monroe | Counselor | 111 Lamon St Ste 100, Fayetteville, NC 28301-4917 | 2020-10-23 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1760032239 | Peyton Elaine Smith | Counselor | 2403 Main Dr Ste 1&2, Fayetteville, AR 72704-5223 | 2019-09-17 |
| 1467014746 | Tennille Kristine Wilson | Counselor | 6415 Camden Rd Ste 109, Fayetteville, NC 28306-7584 | 2019-07-08 |
| 1366914004 | Katie Frankum | Counselor | 6805 Woodmark Dr, Fayetteville, NC 28314-6458 | 2018-12-19 |
| 1588132534 | Sara Penney | Counselor | 351 Wagoner Dr Ste 135, Fayetteville, NC 28303-4608 | 2018-11-07 |
| 1578045589 | Tamara Smith Thom | Counselor | 2307 Cumberland Gap Dr, Fayetteville, NC 28306-6940 | 2018-09-06 |
| 1003393968 | Melissa Stone Martinez | Counselor | 175 Bradford Sq Ste D, Fayetteville, GA 30215-1967 | 2018-07-24 |
| 1629561568 | Hamlin Glover Consulting Group, LLC | Counselor | 3681 Raeburn Ct, Fayetteville, NC 28314-2623 | 2018-06-13 |
| 1861983439 | Jessica Lynne Smith | Counselor | 6885 Cliffdale Rd Ste 2002, Fayetteville, NC 28314 | 2018-05-19 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28303 |
Please comment or provide details below to improve the information on CARDINAL CLINIC L.L.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.