Healthcare Provider Details

I. General information

NPI: 1528405305
Provider Name (Legal Business Name): CENTER FOR BEHAVIORAL HEALTHCARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 E CARDINAL ST
SILER CITY NC
27344-3300
US

IV. Provider business mailing address

138 S STEELE ST SUITE P
SANFORD NC
27330-4201
US

V. Phone/Fax

Practice location:
  • Phone: 919-663-3050
  • Fax: 919-663-3080
Mailing address:
  • Phone: 919-776-0303
  • Fax: 919-776-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC00038
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3410094
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier2860257C
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name: LAURIE M. CONATY
Title or Position: CLINICAL DIRECTOR
Credential: MSW, LCSW, LCAS
Phone: 919-776-0303