Provider Demographics
NPI:1619959871
Name:DELTA BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:DELTA BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:VUOCOLO
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-343-6890
Mailing Address - Street 1:1606 PHYSICIANS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7348
Mailing Address - Country:US
Mailing Address - Phone:910-343-6890
Mailing Address - Fax:910-332-1233
Practice Address - Street 1:1606 PHYSICIANS DR STE 104
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7348
Practice Address - Country:US
Practice Address - Phone:910-343-6890
Practice Address - Fax:910-332-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900838Medicaid
NC6005548Medicaid