Healthcare Provider Details

I. General information

NPI: 1538618038
Provider Name (Legal Business Name): STANDARDS-BASED SOLUTIONS BEHAVIORAL HEALTH CONSULTING & MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 09/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E HARDEN ST
GRAHAM NC
27253-3001
US

IV. Provider business mailing address

1301 E FRANKLIN ST
CHAPEL HILL NC
27514-3319
US

V. Phone/Fax

Practice location:
  • Phone: 919-967-9964
  • Fax: 919-967-9965
Mailing address:
  • Phone: 919-967-9964
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MILDRED S JOHNSON
Title or Position: CEO
Credential: MA MSW
Phone: 919-672-4472