Provider Demographics
NPI:1053444083
Name:THE MENTAL HEALTH ASSOCIATION IN NORTH CAOLINA, INC
Entity Type:Organization
Organization Name:THE MENTAL HEALTH ASSOCIATION IN NORTH CAOLINA, INC
Other - Org Name:WILSON-GREENE-JOHNSON ACTT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-981-0740
Mailing Address - Street 1:1331 SUNDAY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-981-0740
Mailing Address - Fax:
Practice Address - Street 1:210 BRIDGE ST STE 102
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3904
Practice Address - Country:US
Practice Address - Phone:919-989-9936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300434GMedicaid