Provider Demographics
NPI:1386992345
Name:CAP FEAR CLINIC (MENTAL HEALTH)
Entity type:Organization
Organization Name:CAP FEAR CLINIC (MENTAL HEALTH)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR, PHARMACY SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:910-343-8736
Mailing Address - Street 1:1605 DOCTORS CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7405
Mailing Address - Country:US
Mailing Address - Phone:910-343-8736
Mailing Address - Fax:
Practice Address - Street 1:1605 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7405
Practice Address - Country:US
Practice Address - Phone:910-343-8736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPE FEAR CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)