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General NPI Number Information
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NPI Number | 1528563194
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Entity Type | Organization
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Legal Business Name | THREE OAKS BEHAVIORAL HEALTH & WELLNESS
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 1013 BULLARD CT STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-6801
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Country | US
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Telephone | 252-430-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 BULLARD CT STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-6801
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Country | US
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Telephone | 252-430-4466
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CASIE HALL
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Credential | MS, CRC, LPC, LCASA
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Telephone | 252-430-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-21329
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11825
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License Number State | NC
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