GREAT EXPECTATIONS MENTAL HEALTH SERVICES INC

Provider Demographics

• NPI: 1548322175
• Name: GREAT EXPECTATIONS MENTAL HEALTH SERVICES INC
• Entity type: Organization
• Organization Name: GREAT EXPECTATIONS MENTAL HEALTH SERVICES INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: OWNER PRESIDENT
• Authorized Official - Prefix: MR
• Authorized Official - First Name: ANTHONY
• Authorized Official - Middle Name: CHARLES
• Authorized Official - Last Name: PACKER
• Authorized Official - Phone: 910-860-3325
• Mailing Address - Street 1: PO BOX 40353
• Mailing Address - Street 2: 2151 SKIBO RD STE 100
• Mailing Address - City: FAYETTEVILLE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28314-0237
• Mailing Address - Country: US
• Mailing Address - Phone: 910-860-3325
• Mailing Address - Fax: 910-860-3345
• Practice Address - Street 1: 2151 SKIBO RD
• Practice Address - Street 2: SUITE 100
• Practice Address - City: FAYETTEVILLE
• Practice Address - State: NC
• Practice Address - Zip Code: 28314-0237
• Practice Address - Country: US
• Practice Address - Phone: 910-860-3325
• Practice Address - Fax: 910-860-3345
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-12-13
• Last Update Date: 2007-10-05

Provider Licenses

State	License ID	Taxonomies
NC	8300907	251B00000X, 251S00000X
NC	6603654	320600000X, 322D00000X
NC	6603429	320900000X, 322D00000X
NC	4660	101YP2500X
NC	1837	103T00000X
NC	1017	101YA0400X
NC	2513	103T00000X
NC	5158	101YP2500X
NC	6604172	320600000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	251S00000X	Agencies	Community/Behavioral Health
No	251B00000X	Agencies	Case Management		Group - Multi-Specialty
No	320600000X	Residential Treatment Facilities	Residential Treatment Facility, Intellectual and/or Developmental Disabilities		Group - Multi-Specialty
No	320900000X	Residential Treatment Facilities	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	322D00000X	Residential Treatment Facilities	Residential Treatment Facility, Emotionally Disturbed Children

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	8300907G	Medicaid
NC	6604172	Medicaid
NC	6603429	Medicaid
NC	8300907B	Medicaid
NC	8300907H	Medicaid
NC	6603654	Medicaid