Healthcare Provider Details

I. General information

NPI: 1285236760
Provider Name (Legal Business Name): CAROLINA BEHAVIORAL HEALTH AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BANDON DR
NEW BERN NC
28562-2300
US

IV. Provider business mailing address

101 BANDON DR
NEW BERN NC
28562-2300
US

V. Phone/Fax

Practice location:
  • Phone: 919-522-7351
  • Fax:
Mailing address:
  • Phone: 919-522-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIZZY H PETERSEN
Title or Position: PRESIDENT
Credential: FNP, PMHNP
Phone: 919-522-7351