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General NPI Number Information
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NPI Number | 1639087323
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Entity Type | Organization
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Legal Business Name | JRC MENTAL HEALTH SERVICE LLC
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 1600 TOWER CT
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City | MONROE
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State | NC
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Zip | 28112-4528
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Country | US
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Telephone | 704-219-9950
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 TOWER CT
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City | MONROE
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State | NC
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Zip | 28112-4528
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Country | US
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Telephone | 704-219-9950
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Fax |
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Authorized Official
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Title or Position | QUALIFIED PROFESSIONAL (QP)
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Name | MR. TONY LAMAR JAMES
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Credential |
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Telephone | 704-219-9950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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