Healthcare Provider Details

I. General information

NPI: 1255768099
Provider Name (Legal Business Name): STANDARDS-BASED SOLUTIONS BEHAVIORAL HEALTH CONSULTING & MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 LYCKAN PKWY 201
DURHAM NC
27707-2586
US

IV. Provider business mailing address

20082 LONG
CHAPEL HILL NC
27517-7339
US

V. Phone/Fax

Practice location:
  • Phone: 919-951-8919
  • Fax: 919-967-9965
Mailing address:
  • Phone: 919-951-8919
  • Fax: 919-967-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MILDRED SHAW JOHNSON
Title or Position: CEO
Credential: MSW
Phone: 919-951-8919