Healthcare Provider Details

I. General information

NPI: 1255485017
Provider Name (Legal Business Name): ALBEMARLE MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6644 CARATOKE HWY
GRANDY NC
27939
US

IV. Provider business mailing address

6644 CARATOKE HWY
GRANDY NC
27939
US

V. Phone/Fax

Practice location:
  • Phone: 252-453-8886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8300770
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: CHARLES FRANKLIN JR.
Title or Position: AREA DIRECTOR
Credential:
Phone: 252-335-1113