Healthcare Provider Details

I. General information

NPI: 1659134146
Provider Name (Legal Business Name): OPTUM BEHAVIORAL CARE OF NORTH CAROLINA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E SIX FORKS RD STE 117
RALEIGH NC
27609-7753
US

IV. Provider business mailing address

11000 OPTUM CIR
EDEN PRAIRIE MN
55344-2503
US

V. Phone/Fax

Practice location:
  • Phone: 919-833-8899
  • Fax: 919-833-8894
Mailing address:
  • Phone: 704-506-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA MARIE STEELMAN
Title or Position: SECRETARY
Credential:
Phone: 704-506-6267