Healthcare Provider Details

I. General information

NPI: 1417881715
Provider Name (Legal Business Name): CITIZENS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 CENTERVIEW DR
RALEIGH NC
27606-3363
US

IV. Provider business mailing address

4220 BEACON CREST WAY
RALEIGH NC
27604-8318
US

V. Phone/Fax

Practice location:
  • Phone: 919-633-9397
  • Fax:
Mailing address:
  • Phone: 919-633-9397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL JACK
Title or Position: CEO
Credential:
Phone: 919-633-9397