Healthcare Provider Details

I. General information

NPI: 1134255029
Provider Name (Legal Business Name): UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CONNER DR APT 17
CHAPEL HILL NC
27514-7023
US

IV. Provider business mailing address

410 N GREENSBORO ST SUITE 220
CARRBORO NC
27510-1870
US

V. Phone/Fax

Practice location:
  • Phone: 919-960-3775
  • Fax: 919-960-3799
Mailing address:
  • Phone: 919-966-9803
  • Fax: 919-966-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number068114
License Number StateNC

VIII. Authorized Official

Name: HENDREE JONES
Title or Position: DIRECTOR
Credential: PHD
Phone: 919-966-9803