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NPI Code Detail

MEDICARE: JACKSONVILLE TREATMENT CENTER

MEDICARE: JACKSONVILLE TREATMENT CENTER
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QM2800XMethadone ClinicMHL-067-166NC
2251S00000XCommunity/Behavioral Health AgencyMHL-067-166NC

General Provider Information

NPI Number : 1750821229
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACKSONVILLE TREATMENT CENTER
Provider Business Mailing Address
First Line : 1112 SILVER OAKS CT
Second Line :
City : RALEIGH
State : NC
Zip : 27614-9359
Country : US
Telephone Number : 919-656-1633
Fax Number :
Provider Business Practice Location Address
First Line : 291 HUFF DR
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-7370
Country : US
Telephone Number : 910-347-2205
Fax Number : 910-347-2216
Authorized Official
Title or Position : SPONSOR
Name : MACY MELISSA HAMM
Credential : J.D.
Telephone Number : 919-656-1633
Provider Enumeration Date : 03/03/2017
Last Update Date : 02/09/2026

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1871145953 — SHAKIRA N BELL MS, LCAS, CCS-I
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1447997903 — FELICIANA INOCENTA QUINN
Practice Location Address:
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28546-7370
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Directions to “JACKSONVILLE TREATMENT CENTER ” Practice Location

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