Provider Demographics
NPI:1124193636
Name:MENTAL HEALTH CENTER OF NORTH CENTRAL ALABAMA INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH CENTER OF NORTH CENTRAL ALABAMA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:256-260-7330
Mailing Address - Street 1:1316 SOMERVILLE RD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4309
Mailing Address - Country:US
Mailing Address - Phone:256-355-6105
Mailing Address - Fax:256-341-0747
Practice Address - Street 1:4110 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1644
Practice Address - Country:US
Practice Address - Phone:256-355-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51009252OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL590000008Medicaid
AL51008101OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL330034008Medicaid
AL330000008Medicaid
AL51008101OtherBLUE CROSS BLUE SHIELD OF ALABAMA
ALF078Medicare UPIN
ALD079Medicare UPIN