Healthcare Provider Details

I. General information

NPI: 1487977021
Provider Name (Legal Business Name): MEBANE BEHAVIORAL HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E CENTER ST SUITE B-3
MEBANE NC
27302-2420
US

IV. Provider business mailing address

105 E CENTER ST SUITE B-3
MEBANE NC
27302-2420
US

V. Phone/Fax

Practice location:
  • Phone: 919-563-2140
  • Fax: 919-563-2188
Mailing address:
  • Phone: 919-563-2140
  • Fax: 919-563-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2046
License Number StateNC

VIII. Authorized Official

Name: DR. CHARLES K. BURNETT
Title or Position: PRESIDENT
Credential: PHD
Phone: 919-563-2140