34D2081696 CLIA NUMBER - INNOVATIVE BEHAVIORAL HEALTH SERVICES, PC

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Laboratory Demographics

CLIA Number: 34D2081696

Facility Name: INNOVATIVE BEHAVIORAL HEALTH SERVICES, PC

Facility Address:
402 NORTH MAIN STREET
CREEDMOOR, NC
ZIP 27522
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Facility Phone Number: 919 529-2474

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1124367347

Taxonomy: 261QM1300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	5/10/2023
CertificateExpirationDate	5/9/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024