Provider Demographics
NPI:1710002456
Name:MENTAL HEALTH ASSOCIATES OF THE TRIAD
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATES OF THE TRIAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTAKE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-822-2827
Mailing Address - Street 1:PO BOX 5693
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-5693
Mailing Address - Country:US
Mailing Address - Phone:336-822-2827
Mailing Address - Fax:336-883-4015
Practice Address - Street 1:910 MILL AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-1628
Practice Address - Country:US
Practice Address - Phone:336-822-2827
Practice Address - Fax:336-883-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008084Medicaid