Healthcare Provider Details

I. General information

NPI: 1770358095
Provider Name (Legal Business Name): OPTUM BEHAVIORAL CARE OF NORTH CAROLINA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 S GERMANTOWN RD
GERMANTOWN TN
38138-3805
US

IV. Provider business mailing address

11000 OPTUM CIR
EDEN PRAIRIE MN
55344-2503
US

V. Phone/Fax

Practice location:
  • Phone: 901-753-4300
  • Fax:
Mailing address:
  • Phone: 704-506-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: VIRGINIA MARIE STEELMAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 704-506-6267