Healthcare Provider Details

I. General information

NPI: 1750821229
Provider Name (Legal Business Name): JACKSONVILLE TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 HUFF DR
JACKSONVILLE NC
28546-7370
US

IV. Provider business mailing address

1112 SILVER OAKS CT
RALEIGH NC
27614-9359
US

V. Phone/Fax

Practice location:
  • Phone: 910-347-2205
  • Fax: 910-347-2216
Mailing address:
  • Phone: 919-656-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-067-166
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberMHL-067-166
License Number StateNC

VIII. Authorized Official

Name: MACY MELISSA HAMM
Title or Position: SPONSOR
Credential: J.D.
Phone: 919-656-1633