Healthcare Provider Details

I. General information

NPI: 1154589208
Provider Name (Legal Business Name): THE MENTAL HEALTH ASSOCIATION IN NC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 RAYNOR ST APT A-1
DURHAM NC
27703-2239
US

IV. Provider business mailing address

1331 SUNDAY DR
RALEIGH NC
27607-5166
US

V. Phone/Fax

Practice location:
  • Phone: 919-688-6200
  • Fax: 919-688-7606
Mailing address:
  • Phone: 919-981-0740
  • Fax: 919-954-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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