Healthcare Provider Details

I. General information

NPI: 1689809782
Provider Name (Legal Business Name): SOUTHEASTERN REGIONAL MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W 29TH ST
LUMBERTON NC
28358-2901
US

IV. Provider business mailing address

450 COUNTRY CLUB RD
LUMBERTON NC
28360-9494
US

V. Phone/Fax

Practice location:
  • Phone: 910-618-5606
  • Fax:
Mailing address:
  • Phone: 910-738-5261
  • Fax: 910-272-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICKI EVANS
Title or Position: CHEIF FINANCE OFFICER
Credential:
Phone: 910-738-5261