Healthcare Provider Details

I. General information

NPI: 1114192259
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: 04/29/2008
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 SOUTHWOOD DR
DURHAM NC
27707-2114
US

IV. Provider business mailing address

1331 SUNDAY DR
RALEIGH NC
27607-5166
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-9051
  • Fax:
Mailing address:
  • Phone: 919-981-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-032-436
License Number StateNC

VIII. Authorized Official

Name: MR. KEVIN LEE COCHRAN
Title or Position: FINANCE ASST.
Credential:
Phone: 919-981-0740