Provider Demographics
NPI:1578699542
Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Other - Org Name:UNC HORIZONS PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENDREE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-966-9803
Mailing Address - Street 1:410 N GREENSBORO ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1870
Mailing Address - Country:US
Mailing Address - Phone:919-966-9803
Mailing Address - Fax:919-966-9169
Practice Address - Street 1:410 N GREENSBORO ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1870
Practice Address - Country:US
Practice Address - Phone:919-966-9803
Practice Address - Fax:919-966-9169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-068-107251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300698BMedicaid
NC8300698PMedicaid
NC8300698Medicaid
NC8300698GMedicaid