34D2081696 CLIA NUMBER - INNOVATIVE BEHAVIORAL HEALTH SERVICES, PC

Laboratory Demographics

  • CLIA Code: 34D2081696
  • Facility Name: INNOVATIVE BEHAVIORAL HEALTH SERVICES, PC
  • Facility Address: 402 NORTH MAIN STREET
    CREEDMOOR, NC
    ZIP 27522
  • Facility Phone: 919 529-2474
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BENJAMIN MASTRIDGE
  • NPI Number: 1124367347
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 34D2081696
LAB Type Physician Office
Facility Name INNOVATIVE BEHAVIORAL HEALTH SERVICES, PC
Street 402 NORTH MAIN STREET
City CREEDMOOR
State NC
ZIP 27522
Phone 919 529-2474
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2025
Certificate Expiration Date 5/9/2027
Facility Type Physician Office
Lab Director BENJAMIN MASTRIDGE

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This page was last updated on: 9/29/2025