Healthcare Provider Details

I. General information

NPI: 1639087323
Provider Name (Legal Business Name): JRC MENTAL HEALTH SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 TOWER CT
MONROE NC
28112-4528
US

IV. Provider business mailing address

1600 TOWER CT
MONROE NC
28112-4528
US

V. Phone/Fax

Practice location:
  • Phone: 704-219-9950
  • Fax:
Mailing address:
  • Phone: 704-219-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. TONY LAMAR JAMES
Title or Position: QUALIFIED PROFESSIONAL (QP)
Credential:
Phone: 704-219-9950