ADVANTAGE BEHAVIORAL HEALTHCARE INC.

Provider Demographics

• NPI: 1902100019
• Name: ADVANTAGE BEHAVIORAL HEALTHCARE INC.
• Entity Type: Organization
• Organization Name: ADVANTAGE BEHAVIORAL HEALTHCARE INC.
• Authorized Official - Title/Position: COO
• Authorized Official - Prefix: DR
• Authorized Official - First Name: BARRY
• Authorized Official - Middle Name: WALSTER
• Authorized Official - Last Name: GRAHAM
• Authorized Official - Credentials: PHD, CBIS
• Authorized Official - Phone: 910-640-1038
• Mailing Address - Street 1: 732 DAVIS AVE
• Mailing Address - City: WHITEVILLE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28472-6002
• Mailing Address - Country: US
• Mailing Address - Phone: 910-640-1038
• Mailing Address - Fax: 910-640-1465
• Practice Address - Street 1: 732 DAVIS AVE
• Practice Address - City: WHITEVILLE
• Practice Address - State: NC
• Practice Address - Zip Code: 28472-6002
• Practice Address - Country: US
• Practice Address - Phone: 910-640-1038
• Practice Address - Fax: 910-640-1465
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2011-01-04
• Last Update Date: 2011-01-25

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	101Y00000X	Behavioral Health & Social Service Providers	Counselor		Group - Multi-Specialty
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	106H00000X	Behavioral Health & Social Service Providers	Marriage & Family Therapist		Group - Multi-Specialty
No	251B00000X	Agencies	Case Management
No	251C00000X	Agencies	Day Training, Developmentally Disabled Services
No	251S00000X	Agencies	Community/Behavioral Health		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	3418242	Medicaid
NC	3418282	Medicaid
NC	5906566	Medicaid
NC	8302158B	Medicaid
NC	8303167R	Medicaid
NC	8702269	Medicaid
NC	8302629G	Medicaid
NC	5968204	Medicaid
NC	8301619	Medicaid
NC	8301619H	Medicaid
NC	8302158H	Medicaid
NC	8303168R	Medicaid
NC	8301619B	Medicaid
NC	8302158G	Medicaid
NC	6005978	Medicaid
NC	8303167	Medicaid
NC	8303168	Medicaid
NC	8302158	Medicaid