Provider Demographics
NPI:1962705418
Name:ARJ-CABHA
Entity type:Organization
Organization Name:ARJ-CABHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-910-5395
Mailing Address - Street 1:2311 VILLAGE LAKE DR STE 105-262
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-0081
Mailing Address - Country:US
Mailing Address - Phone:980-819-5692
Mailing Address - Fax:
Practice Address - Street 1:2311 VILLAGE LAKE DR STE 105-262
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212
Practice Address - Country:US
Practice Address - Phone:980-819-5692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARJ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-06
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management