Provider Demographics
NPI:1629341607
Name:1ST OPPORTUNITY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:1ST OPPORTUNITY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNELL
Authorized Official - Middle Name:LEVON
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-345-6882
Mailing Address - Street 1:2712 HOPE DIAMOND CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5996
Mailing Address - Country:US
Mailing Address - Phone:919-345-6882
Mailing Address - Fax:
Practice Address - Street 1:2949 NEW BERN AVE
Practice Address - Street 2:SUITE 110-B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1248
Practice Address - Country:US
Practice Address - Phone:919-345-6882
Practice Address - Fax:919-900-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty