Provider Demographics
NPI:1780743062
Name:AUTISM SOCIETY OF CUMBERLAND COUNTY
Entity type:Organization
Organization Name:AUTISM SOCIETY OF CUMBERLAND COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMS AND OUTREACH
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:SETLIFF
Authorized Official - Last Name:PFUNTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:910-826-9100
Mailing Address - Street 1:PO BOX 35600
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-0600
Mailing Address - Country:US
Mailing Address - Phone:910-826-9100
Mailing Address - Fax:910-868-5881
Practice Address - Street 1:351 WAGONER DR STE 410
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4670
Practice Address - Country:US
Practice Address - Phone:910-826-9100
Practice Address - Fax:910-868-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-244251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services