MEDICARE: ALBEMARLE MENTAL HEALTH CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist
4	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07051	OTHER	NC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821282344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBEMARLE MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	102 MEDICAL DR
Second Line	:
City	:	WILLIAMSTON
State	:	NC
Zip	:	27892-2156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 MEDICAL DR
Second Line	:
City	:	WILLIAMSTON
State	:	NC
Zip	:	27892-2156
Country	:	US
Telephone Number	:	252-792-5151
Fax Number	:

Authorized Official
Title or Position	:	AREA DIRECTOR
Name	:	CHARLES FRANKLIN
Credential	:
Telephone Number	:	252-335-1113

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	02/08/2008

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