Provider Demographics
NPI:1366627937
Name:UNC
Entity Type:Organization
Organization Name:UNC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RENZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-966-9803
Mailing Address - Street 1:400 ROBERSON ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2367
Mailing Address - Country:US
Mailing Address - Phone:919-966-9803
Mailing Address - Fax:
Practice Address - Street 1:209 CONNER DR APT 17
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7023
Practice Address - Country:US
Practice Address - Phone:919-960-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC068107320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300699BMedicaid