Healthcare Provider Details

I. General information

NPI: 1093017162
Provider Name (Legal Business Name): COMPREHENSIVE MENTAL HEALTH, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 FOREST HILL AVE SUITE 102
ROCKY MOUNT NC
27804-3728
US

IV. Provider business mailing address

114 FOREST HILL AVE # 102
ROCKY MOUNT NC
27804-3728
US

V. Phone/Fax

Practice location:
  • Phone: 252-414-8202
  • Fax: 252-443-2948
Mailing address:
  • Phone: 252-414-8202
  • Fax: 252-443-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. OMA GAMA
Title or Position: PART OWNER
Credential: PA-C
Phone: 252-414-8202