Healthcare Provider Details

I. General information

NPI: 1467275099
Provider Name (Legal Business Name): BASIN CREEK BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 S CENTER CHURCH RD
THURMOND NC
28683-9683
US

IV. Provider business mailing address

499 S CENTER CHURCH RD
THURMOND NC
28683-9683
US

V. Phone/Fax

Practice location:
  • Phone: 828-406-6055
  • Fax:
Mailing address:
  • Phone: 828-406-6055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN WILMOTH
Title or Position: NP, OWNER
Credential:
Phone: 828-406-6055