Healthcare Provider Details

I. General information

NPI: 1467594499
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: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5847 PAUL GREEN MEMORIAL HWY
BUIES CREEK NC
27506-0457
US

IV. Provider business mailing address

3820 BLAND RD
RALEIGH NC
27609-6239
US

V. Phone/Fax

Practice location:
  • Phone: 910-814-0820
  • Fax: 910-814-0827
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 NumberMHL-043-029
License Number StateNC

VIII. Authorized Official

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