Healthcare Provider Details

I. General information

NPI: 1821130642
Provider Name (Legal Business Name): CHRYSALIS FOUNDATION FOR MENTAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SANFORD RD
PITTSBORO NC
27312-9423
US

IV. Provider business mailing address

101 E WEAVER ST SUITE G-7
CARRBORO NC
27510-2370
US

V. Phone/Fax

Practice location:
  • Phone: 919-542-7432
  • Fax:
Mailing address:
  • Phone: 919-933-0770
  • Fax: 919-933-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-019-024
License Number StateNC

VIII. Authorized Official

Name: MR. JEFFERSON DOUGLAS PARKER
Title or Position: ACTING EXECUTIVE DIRECTOR
Credential:
Phone: 919-933-0828