Provider Demographics
NPI:1093438673
Name:NORTH CAROLINA CENTER FOR BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:NORTH CAROLINA CENTER FOR BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:253-576-3898
Mailing Address - Street 1:181 WIND CHIME CT STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6573
Mailing Address - Country:US
Mailing Address - Phone:253-576-3898
Mailing Address - Fax:
Practice Address - Street 1:181 WIND CHIME CT STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6573
Practice Address - Country:US
Practice Address - Phone:253-576-3898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty