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General NPI Number Information
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NPI Number | 1629341607
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Entity Type | Organization
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Legal Business Name | 1ST OPPORTUNITY BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 2949 NEW BERN AVE SUITE 110-B
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City | RALEIGH
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State | NC
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Zip | 27610-1248
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Country | US
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Telephone | 919-345-6882
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Fax | 919-900-7018
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Provider Business Mailing Address
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Address Line | 2712 HOPE DIAMOND CT
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City | RALEIGH
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State | NC
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Zip | 27610-5996
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Country | US
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Telephone | 919-345-6882
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONNELL LEVON MCGILL
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Credential |
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Telephone | 919-345-6882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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