Provider Demographics
NPI:1578999827
Name:NORTH CAROLINA STATE UNIVERSITY
Entity Type:Organization
Organization Name:NORTH CAROLINA STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHANCELLOR, FINANCE & BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-515-2155
Mailing Address - Street 1:BOX 7201, HOLLADAY HALL B
Mailing Address - Street 2:NCSU CAMPUS
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27695
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:512 BRICKHAVEN DR
Practice Address - Street 2:SUITE 240A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1492
Practice Address - Country:US
Practice Address - Phone:919-515-9142
Practice Address - Fax:919-515-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health