Healthcare Provider Details

I. General information

NPI: 1356153761
Provider Name (Legal Business Name): MRH COUNSELING AND BEHAVIORAL HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 ARAGON DR APT 104
KNIGHTDALE NC
27545-6023
US

IV. Provider business mailing address

1520 ARAGON DR APT 104
KNIGHTDALE NC
27545-6023
US

V. Phone/Fax

Practice location:
  • Phone: 631-384-1713
  • Fax:
Mailing address:
  • Phone: 631-384-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARY HALL
Title or Position: OWNER AND CLINICIAN
Credential: LCSW
Phone: 631-384-1713