Provider Demographics
NPI:1073753463
Name:SOUTHEASTERN TREATMENT SERVICES, LLC.
Entity Type:Organization
Organization Name:SOUTHEASTERN TREATMENT SERVICES, LLC.
Other - Org Name:IALAC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-258-2541
Mailing Address - Street 1:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-1584
Mailing Address - Country:US
Mailing Address - Phone:910-844-3233
Mailing Address - Fax:910-844-3241
Practice Address - Street 1:109 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1703
Practice Address - Country:US
Practice Address - Phone:910-844-3233
Practice Address - Fax:910-844-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-220251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health