Healthcare Provider Details

I. General information

NPI: 1336178524
Provider Name (Legal Business Name): SANDHILLS CENTER FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 OLD LILESVILLE RD
WADESBORO NC
28170-2820
US

IV. Provider business mailing address

PO BOX 9
WEST END NC
27376-0009
US

V. Phone/Fax

Practice location:
  • Phone: 704-694-6588
  • Fax: 704-694-6706
Mailing address:
  • Phone: 910-673-9111
  • Fax: 910-673-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TOMMY E. SCOTT
Title or Position: CFO
Credential:
Phone: 910-673-9111