Healthcare Provider Details

I. General information

NPI: 1447481510
Provider Name (Legal Business Name): CARE FIRST MENTAL HEALTH, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 FOREST HILL AVE
ROCKY MOUNT NC
27804-3728
US

IV. Provider business mailing address

PO BOX 30365
GREENVILLE NC
27833-0365
US

V. Phone/Fax

Practice location:
  • Phone: 252-628-8300
  • Fax: 252-642-6622
Mailing address:
  • Phone: 252-628-8300
  • Fax: 252-642-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29064
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00147
License Number StateNC

VIII. Authorized Official

Name: OMA GAMA
Title or Position: OWNER
Credential: PA
Phone: 252-628-8300