MEDICARE: CITIZENS BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician

General Provider Information

NPI Number	:	1417881715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITIZENS BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	4220 BEACON CREST WAY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-8318
Country	:	US
Telephone Number	:	919-633-9397
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 CENTERVIEW DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3363
Country	:	US
Telephone Number	:	919-633-9397
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DANIEL JACK
Credential	:
Telephone Number	:	919-633-9397

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/16/2026

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