Healthcare Provider Details

I. General information

NPI: 1205503471
Provider Name (Legal Business Name): G & C BEHAVIORAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8504 SIX FORKS RD STE 204
RALEIGH NC
27615-3265
US

IV. Provider business mailing address

8504 SIX FORKS RD STE 204
RALEIGH NC
27615-3265
US

V. Phone/Fax

Practice location:
  • Phone: 252-629-4291
  • Fax:
Mailing address:
  • Phone: 252-629-4291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DIANA CAMPBELL
Title or Position: ORGANIZER
Credential: PMHNP
Phone: 203-528-5447