Healthcare Provider Details

I. General information

NPI: 1215452032
Provider Name (Legal Business Name): PHASE 2 BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 07/21/2022
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3592 KNIGHT ARNOLD RD STE 204
MEMPHIS TN
38118-2709
US

IV. Provider business mailing address

233 WESTCHESTER RD
WILMINGTON NC
28409-8509
US

V. Phone/Fax

Practice location:
  • Phone: 910-899-3354
  • Fax:
Mailing address:
  • Phone: 910-550-8676
  • Fax: 404-393-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. TERRIE SIMPSON
Title or Position: PARTNER
Credential:
Phone: 910-899-3354