Provider Demographics
NPI:1689809782
Name:SOUTHEASTERN REGIONAL MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTHEASTERN REGIONAL MENTAL HEALTH CENTER
Other - Org Name:ARBOR CAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF FINANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-5261
Mailing Address - Street 1:450 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-9494
Mailing Address - Country:US
Mailing Address - Phone:910-738-5261
Mailing Address - Fax:910-272-1299
Practice Address - Street 1:207 W 29TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2901
Practice Address - Country:US
Practice Address - Phone:910-618-5606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty