Provider Demographics
NPI:1407188832
Name:UNIFIED BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:UNIFIED BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:252-402-7298
Mailing Address - Street 1:139 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4970
Mailing Address - Country:US
Mailing Address - Phone:252-402-7298
Mailing Address - Fax:252-940-7261
Practice Address - Street 1:139 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4970
Practice Address - Country:US
Practice Address - Phone:252-402-7298
Practice Address - Fax:252-940-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X, 253Z00000X
NCMHL-007-062322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700537Medicaid
NC6604171Medicaid
NC8301781Medicaid