Healthcare Provider Details

I. General information

NPI: 1306197629
Provider Name (Legal Business Name): COLONY BEHAVIORAL HEALTH GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 NEUSE BLVD STE 3
NEW BERN NC
28562-2815
US

IV. Provider business mailing address

2807 NEUSE BLVD STE 3
NEW BERN NC
28562-2815
US

V. Phone/Fax

Practice location:
  • Phone: 252-636-0112
  • Fax: 252-634-9778
Mailing address:
  • Phone: 252-636-0112
  • Fax: 252-634-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BETHANNE T JACOBSON
Title or Position: OWNER
Credential: PHD
Phone: 252-636-0112