Healthcare Provider Details

I. General information

NPI: 1588706410
Provider Name (Legal Business Name): THE MENTAL HEALTH ASSOCIATION IN NORTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 S COX ST
ASHEBORO NC
27203-6466
US

IV. Provider business mailing address

1331 SUNDAY DR
RALEIGH NC
27607
US

V. Phone/Fax

Practice location:
  • Phone: 336-633-7289
  • Fax:
Mailing address:
  • Phone: 919-981-0740
  • Fax: 919-954-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KEVIN COCHRAN
Title or Position: FINANCIAL ASSISTANT
Credential:
Phone: 919-981-0740