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General NPI Number Information
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NPI Number | 1932304714
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN BEHAVIORAL HEALTHCARE SERVICES
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 3581 LACKEY ST
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City | LUMBERTON
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State | NC
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Zip | 28360-9048
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Country | US
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Telephone | 910-738-1587
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Fax | 910-738-1581
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Provider Business Mailing Address
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Address Line | PO BOX 1004
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City | LUMBERTON
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State | NC
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Zip | 28359-1004
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Country | US
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Telephone | 910-738-1587
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Fax | 910-738-1581
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Authorized Official
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Title or Position | CEO
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Name | VIRGIL L HUTCHINSON
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Credential |
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Telephone | 910-738-1587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C00269
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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